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MENTAL HEALTH & DADS CONTRACTOR EHR PLANNING MEETING
May 25, 2011
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AGENDA
Welcome & Introductions
Breakout Sessions MH & DADS
Funding Methodology
Funding Application
Bring MH and DADS back together
Next Steps
MENTAL HEALTH & DADS CONTRACTOR EHR PLANNING MEETING May 25, - - PowerPoint PPT Presentation
MENTAL HEALTH & DADS CONTRACTOR EHR PLANNING MEETING May 25, - - PowerPoint PPT Presentation
MENTAL HEALTH & DADS CONTRACTOR EHR PLANNING MEETING May 25, 2011 AGENDA Welcome & Introductions Breakout Sessions MH & DADS Funding Methodology Funding Application Bring MH and DADS back together Next
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DADS AND MENTAL HEALTH BREAKOUT SESSINS
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County & Contractor Methodology Committee
Purpose:
Develop and implement a methodology and criteria to be used in allocating available funds to Mental Health Short Doyle contract agencies for their transition to an electronic health record (EHR) system.
FUNDING & FUNDING PROCESS
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Funding should be reviewed in relation to meeting minimum requirements for all agencies.
All current Short Doyle Mental Health Contractors will be considered for some MHSA Technological Needs funding based on need.
COMMITTEE PRINCIPLES
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Bruce Copley Deputy Director MHD / County Sponsor Liaison
Sheila Yuter County MHD / Committee Co‐Chair
Erin O’Brien AMCHA / Committee Co‐Chair
Jorge Wong AACI / AMHCA Member
Rachel Clausen EMQ Families First / AMHCA Member
Michael Hutchinson County DADS / QI Clinical Standards
Terry Boyle Unity Care / Non AMCHA “At large” Member
Bruce Fielding Children’s Health Council / “At large” Member
Alyce Cobb County MHD Contract Monitor
Lauren Gavin County MHD Contract Monitor
Sue Clements County EHR Project Manager
Tony Perez County Procurement Department
Martha Paine County General Fund Finance Director
Christine Trong Pathway Society / DADS
Gina Trepagnier Hope Services / Small Agency Representative
COMMITTEE MEMBERS
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SCCo will have up to $4M to award to contractors
Amounts are “not to exceed” and will be considered planning estimates, not fixed amounts
Planning estimates will be based on ‐‐
Meeting EHR minimum requirements
Agency’s need specifically related to meeting EHR minimum requirements by December 31, 2013
FUNDING METHODOLGY
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General approach
Smaller agencies may be awarded more than larger
- nes, but no award will be more than 20% of an
agency’s annual SCCo Mental Health budget
A blended formula was used to determine planning estimates consisting of ‐‐
- an even distribution of one half of the available
funds, plus
- a percent of the remaining half, the percent
being inversely proportional to the size of the agency
Again, no agency’s planning estimate may exceed 20% of
total agency MH budget
FUNDING METHODOLOGY
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Applications will be accepted between June 1 and December 30, 2011
The application for funding contains three parts:
General information
Statement of readiness
Budget
APPLICATION PROCESS
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New or existing system?
ASP (contract for external service) or Self Host (own and maintain yourself)?
Complete minimum requirements checklist
Provide implementation plan and timeline
Provide signed (or to be signed) contract
% of your budget that is used for SCCo MH
READINESS
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Applications will be reviewed by MH and IT staff
Individual meetings to discuss proposal
Expect up to 8 weeks to process and develop contract
REVIEW AND AWARD
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The minimum requirements for an EHR and electronic data exchange that must be met to receive County funds.
County will further define the data that will be necessary to meet these requirements; including data format and method for which the County will receive the secure HIPAA compliant files
MINIMUM REQUIREMENTS
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For each requirement, indicate if it is:
Existing:
Already installed and/or in use
In Progress:
Is in the process of being installed and/or used
Planned:
Is being planned for in the future.
Implementation Date:
For requirements that are in progress
- r planned
, please indicate the estimated date for completion.
MINIMUM REQUIREMENTS
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The minimum requirements for an EHR and electronic data exchange that must be met to receive County funds.
County will further define the data that will be necessary to meet these requirements; including data format and method for which the County will receive the secure HIPAA compliant files
MINIMUM REQUIREMENTS
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For each requirement, indicate if it is:
Existing:
Already installed and/or in use
In Progress:
Is in the process of being installed and/or used
Planned:
Is being planned for in the future.
Implementation Date:
For requirements that are in progress
- r planned
, please indicate the estimated date for completion.
MINIMUM REQUIREMENTS
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# Requirement
1 Certified EHR 2 Security & Privacy 3 Client ID 4 Claim Information 5 Reporting Data (CSI/CALOMS/Other) 6 Additional Demographics 7 Problem List 8 Outcome Measures (e.g. MORS) 9 Transition Care / Referrals
MINIMUM REQUIREMENTS
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# Requirements
10 Electronic Audit Capability 11 Progress Notes 12 Treatment Plans 13 e‐Signature 14 CPOE (Computer Physician Order Entry) 15 e‐Prescribing 16 Maintain Active Medication List 17 Vital Signs 18 Maintain Active Allergy List 19 Consents
MINIMUM REQUIREMENTS
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Information for those that are in the early stages of planning.
This session will cover
Where do you begin?
Technical Considerations
Vendor Demo and Evaluations
Vendor Comparison
Costs
EHR PLANNING SESSION #1
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Information for those that are in the early stages of planning.
This session will cover:
Culture Change
Common Risks
Project Sponsorship
Project and Work Teams
Training
Productivity
Vendor Performance
And more…
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EHR PLANNING SESSION #2
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EHR Planning Session #1 Early Planning
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Information for those that are in the early stages of planning.
This session will cover
Where do you begin?
Technical Considerations
Vendor Demo and Evaluations
Vendor Comparison
Costs
EHR Planning Session #1
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What’s Needed to Get Started?
Start talking about the EHR as a positive change
Prepare staff for changes
Pull Your Team Together
Pick a driver (Agree on the driver)
Include varying disciplines
Set up ongoing meetings
Create realistic timelines
Where do you begin?
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Readiness Assessment
Go through the assessment as a team
Take note where the team does not agree
Recognize areas of need and follow up
Refer back regularly
Track change
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Workflow and Needs
Track how a client moves through the system
Receiving Referral
Treatment
Billing/Payment
Discharge
You want to recognize where the system fails and succeeds
This will help you identify where an EHR may provide improved efficiency, accuracy and better client care
You want a tool that works for you. You don’t want to work for the tool
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What shape is your IT Department in?
Do you have an IT Department?
Who will own the EHR system internally?
Program or Support?
Do you currently have some sort of an EHR system?
What is the reputation of the existing system?
Internal Capabilities
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Do you feel the need for speed?
Cable, T1, Ethernet ready?
Who is in charge?
Do you have someone identified to be primary interface?
Spread the love
Test and Validate with several sets of eyes
Technology Assessment
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Does Staff know what a computer is?
Training capabilities
Does Staff have the time?
Redesign workflow
Implement the system
Validate results
Repeat
Technology Assessment
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Compreh ensive Cost Estimate
Cost of System or Licensing Fees
3rd Party Products and Services
Annual Support
Implementation Services Cost
Hardware
Internal Staff
Project Manager
Systems Analyst
Database Administrator / Trainer
Budget Considerations
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Comprehensive Cost Estimate (continued)
External Consultants
Lost Productivity
Before, During and After Initial Implementation
Custom Programming Fees
Scalability
Adding users in the future
Security
Budget Considerations
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Buy
Internally Hosted on Your Server
Higher Upfront Costs
Nominal Recurring Costs
Rent
ASP (Application Service Provider)
SaS (Software as a Service)
Remotely Hosted via Internet
Low Upfront Costs
Continuous Recurring Costs
Buy v. Rent
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Buy
Not Internet Reliant
Quicker Response / Access Time
Capital Expenditure v. Operating Costs
Data control
Rent
Access from any place with Internet access
Nominal worries about backups, updates, etc.
Upgrades usually built into monthly charge
Less maintenance / IT dependant
Buy v. Rent
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Begin process immediately:
Map existing processes
Outline changes to improve workflow
Identify problem areas – include staffing
Do above in parallel while evaluating vendors – don’t wait!
Utilize a collaborative process
Include clinical and business management and staff
Don’t under change Business needs
Most systems support clinic needs well and “tack on” the business end
Most systems written for counties – how do they insurance claiming, handle private pay, group billing, etc.?
Vendor Comparison
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Software & Hardware Extended Costs Database, billing and clinical workstation, electronic signature, point of service and batch scanning software $ 72,000 Seat licenses (billing and clinical) $ 79,000 Server, scanning and other hardware $ 27,000 Electronic signature pads $ 8,000 Customized software development (group Tx) $ 30,000 Sub Total $ 216,000
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Enterprise Software System Costs
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Implementation Extended Costs Project Management $ 97,000 Software Installation $ 4,000 File Build $ 14,000 Training $ 59,000 Go‐Live Support $ 17,000 Document Management Setup $ 13,000 Forms Development $ 6,000 Infoscribe (electronic prescription) $ 3,000 Sub Total $ 213,000
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Enterprise Software System Costs
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Internal Direct Costs Extended Costs Project Leader $ 100,000 Database, file build and clerical support $ 88,000 Sub Total $ 188,000 Estimate of lost revenues while training rank‐and‐file $ 215,000 Sub Total $ 215,000
Total Estimated Initial Costs $ 832,000
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Enterprise Software System Costs
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Maintenance Extended Costs Annual maintenance contract $ 37,000 Annual internal maintenance cost $ 88,000
Total Annual OnGoing Costs $ 125,000
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Enterprise Software System Costs
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Pay set annual amount based on system total cost
Includes all license fees, installation, and
- ngoing maintenance costs
For the equivalent system detailed above, the annual total is $110K,
Therefore, over 6 years, the total cost is roughly the same – ignoring the time cost of money
The annual obligation continues indefinitely
Pay‐As‐You‐Go (ASP) Arrangement
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Approach as entering into a long‐term partnership – not vendor/customer
One‐sided deals don’t work
Decide early on what elements are most important to the vendor, and which you can push them for concessions
Always have the unseen party who makes decisions for your agency
Make it clear that you will be an active participant in vendors user group
Vendor Negotiations
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Ensure that Vendor warranty covers all product, including third party components
Any Customizations are covered by same warranty, and do not add to maintenance charge after completion
Negotiate a 2‐3 year price freeze for other products not purchased
Include the right to interview the vendor’s proposed project manager & eliminate travel‐time charge
Negotiate the delay of onset of maintenance portion after “go‐live”
Completely define levels of help‐desk, and priority response times – any hours available
Include a provision requiring support of prior release(s)
- f product
Contract Negotiation Considerations
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No charge for subsequent updates and improvements, including enhancements developed in response to user‐ groups
Yearly, vendor will provide a list of all known product problems, bugs, etc.
Set a limit for any increases to the annual maintenance contract cost
Set the hourly installation and consultation cost for a period to avoid cost increases
Require that all software source code be placed in an escrow account to mitigate problems from any business failure of vendor
Include the right to use software in the event of bankruptcy of vendor
Contract Negotiation Considerations
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Ensure Compliance with Federal, State and Local Requirements:
Licensed Programs will comply with the provisions set forth in the California State Department of Mental Health Letter No. 08‐10 as it pertains to electronic signatures. Vendor further warrants that the Licensed Products meet the current and will continue to meet the future compliance standards set by the State of California and/or the applicable County and Federal regulatory requirements for electronic signature and electronic health record, such that Licensee will be in compliance with MediCal/Medicare recordkeeping and billing requirements.
Contract Negotiation Considerations
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Interview vendor’s proposed project team
Set quick deadline for vendor’s timeline/project management plan presentation
Deliver any specifications for customization
Appoint a project manager who has responsibility and authority to get the implementation done
Appoint a cross‐agency group to get the job done
Set sub‐workgroups up from clinical, intake, business
- ffice areas – meet frequently
Be honest with yourselves