EHR Implementation Plan Presentation

Electronic Health Records Implementation Plan for a fictitious community clinic based on implementing MedSphere OpenVista.

1. Community Health Connections Electronic Health Records (EHR) Implementation

2. Individual Role David Montanez Project Manager Luis Perez Clinical Analyst Keri Vogtmann Project Manager Sarah Leake Clinical Analyst Lynda Flower Clinical Analyst Elizabeth Wellner PMS & Billing Analyst Warren Goldberg Risk, Regulation & Stakeholder Analysis Carmen Matthews Training Specialist DeEtte Trubey Project Manager Mona Naoum Project Coordinator Ann Winclair Graphics Designer Panel 1 – Introduction 2

3. Implementación del Sistéma de Records Médico Electrónico Implementing EHR Beneficios en la implementación del EHR Los costos administrativos generales pueden reducirse, Los errores de datos puede reducirse, y Los resultados adversos pueden ser más rápidamente identificados 3

4. CHC Story Founded 30 years Federally Qualified Health Center 3 Clinics Providing Adult Medicine, Women’s Health, Mental Health & Pediatric services Mobile clinic for school programs Laboratory (LAB), Pharmacy (PHM) & Radiology (RAD) at the 3 clinics $1.6 million grant to implement & EHR & meet MU 4

5. EHR Benefits Decreased charting/prescribing errors Improved work-flow Immediate access to Radiology Lab results Patient charts More satisfying work conditions for our employees Freeing up space now used to store charts 5

6. Central Clinic Layout 6

7. West/East Clinic Layout 7

8. Scope & Deliverables Develop Plan to install EHR System Must meet meaningful use Capable of information exchange with National Health Information Network (NHIN) Use OpenVista Realistic plan ready for review on 3/25/2010 Final Deliverables Detailed Implementation Plan with narrative & supporting documents Presentation of Implementation Plan for the Review Committee 8

9. Critical Success Factors Full C-suite support Clinical champion - Chief Medical Officer will lead the Implementation project EHR is a clinical project Organization is stable with quality improvement in place We will achieve a positive return on investment in an EHR 9

10. Assumptions & Constraints Implementation project to begin March 30, 2010, clinic-by-clinic, using Plan Do Study Act (PDSA) process, & completed by February 2011 CHC is compliant with Federal & State regulations, including meaningful use CONNECT Gateway will be used for patient access, Uniform Data System (UDS) reporting & updating the County Immunization Registry Existing use of the Patient Electronic Care System (PECS) registry will migrate to the EHR CHC has at least 30% patient volume enrolled in the Medicaid program A train the trainer approach will be used to minimize vendor-related expenses 10

11. Individual Role DeEtte Trubey Project Manager Keri Vogtmann Project Manager Process Kal Shenoy Project Manager Hardware David Montanez Project Manager Software Mona Naoum Project Coordinator Ann Winclair Graphics Designer Project Management Office 11

12. Process Team Individual Role Keri Vogtmann Project Manager Luis Perez Clinical Analyst Jean Frazier Clinical Analyst Sarah Leake Clinical Analyst Regina Pizarro Practice Management System (PMS) & Billing Analyst Carmen Valladolid Meaningful Use Analyst Elizabeth Wellner Practice Management System (PMS) & Billing Analyst Linda Flower Clinical Analyst Carmen Matthews Training Specialist Eric Smith User Acceptance Testing (UAT) Analyst 12

13. Hardware Team Individual Role Kal Shenoy Project Manager Chris Vu System Engineer Michael Tegardine Network Engineer Josie Aguinaldo Security Administrator Ben de Rosales Jr. Software Engineer Thomas Hoffman Service Desk Manager Victor Cecena Desktop Manager Mona Naoum Project Coordinator 13

14. Software Team Individual Role David Montanez Project Manager Sheldon Penner Software/Database Engineer Ras Desimone Software/Database Engineer Laurelle Palmer Software/Database Engineer Warren Goldberg Risk, Regulation & Stakeholder Analysis Nga Anamosa Engineer Senior Analyst Jacqueline A. Harris Process Analyst 14

15. Stakeholders Management Board, Steering committee, Chief Medical Officer Implementation team PM, Application & clinical specialist, process analysts & Consultants IT Team Integration Architect, DB, Networking, System Admin, Application Development Functional Departments Clinical Team, Billing, Training, Medical records, quality, Pharmacy, Radiology & Libratory departments External Patients, insurance companies, community volunteers, media, Medsphere, government agencies; HHS, NHIN….. 15

16. Communication Plan Purpose Vision What could happen Communication Methods 16

17. Communication Plan - Accountability Type of Communication Responsible Stakeholder Communication Method Community Clinic Marketing & Information Meaningful Use Compliance & Promotion Patient Care Improvement Public Relations Email Website Newsletter Public Service Announcements Government Agencies Communicating Key Project Status Assuring Support for Project Compliance & Regulations Press Releases Incentive & Recognition Programs C Suite/Senior Management Email All-hands Meeting Government Agency Conferences Project Status & Schedule Maintain Organization Chart & Responsibilities Project Milestones (Go/No Go) Issues & Resolutions Project Manager Email Meetings Project Website Implementation Advocate Healthcare Rules, Policies Clinical Information Clinicians Email Meetings Verbal communication 17

18. Compliance Regulatory Level Name Legal & Regulatory Requirements Description Federal HIPAA Health Insurance Portability & Accountability Act of 1996 Privacy Rule & Security Rule Federal PSQIA Patient Safety & Quality Improvement Act of 2005 Patient Safety Rule Federal ARRA American Recovery & Reinvestment Act of 2009 Meaningful Use Reimbursement Federal HITECH Health Information Technology for Economic & Clinical Health Act Initial Set of Standards & Certification Criteria Interim Final Rule HHS Authority & Breach Notification Interim Final Rule Certification Programs – Notice of Proposed Rule (NPRM) State Health Information Exchange Cooperative Agreement Program Health Information Technology Extension Program Federal CFR Code of Federal Regulations Title 42 – Public Health Federal Office for Human Research Protections (OHRP) Compliance Oversight State CCR California Code of Regulations Title 16, Title 17, & Title 22 State CHSC California Health & Safety Code Access Laws on Health & Safety Regulations for Health Facilities & Medical Services National JC Joint Commission of 2004 Documentation & Medical Record Requirements Federal FRCP Federal Rules of Civil Procedure Federal Rules of Admissibility & Electronic Discovery Civil Rule - 2006 State COAL California Office on Administration Law Additional Discovery Rules for Legal Records, both Paper & Electronic 18

19. Regulations CMS - Security/HIPAA Strong organization culture of security: Documented processes to protect ePHI Confidentiality, availability, integrity Training All individuals are personally responsible with severe penalties Roll-out, new hire training, refresher training Real-life case discussions in monthly department meetings Top management priority Talked about often Known organizational auditing 19

20. Security Standards Administrative Security Officer ultimate responsibility Risk Analysis required Roles & privileges process including termination Business relationships Physical Facility controls Media access Workstation access Technical Audits Access control Transmission, firewall, virus security Remote access 20

21. Risk Analysis Methodology Full analysis in Implementation Plan Higher Risk Areas Poor adoption rates Process improvements required Inappropriately used ePHI data Disaster recovery plans Threat Prob Impact Plan Adequacy 1 Low Med > Plan 1 2 Med High > Plan 2 21

22. Current System State 22

23. Future System State 23

24. Medsphere OpenVista EHR Software: OpenVista Leverage billions of dollars of VA software development Open source fosters software enhancements Close relationship with government officials for meaningful use Local company resources Medshpere management understands “open source“ Track Record Hundreds of reference sites including ambulatory sites Proven & quick Stage 6 implementations 24

25. Implementation Schedule 25

26. Panel 2 - Workflow Individual Role Luis Perez Clinical Analyst Jean Frazier Clinical Analyst Keri Vogtmann Project Manager Sarah Leake Clinical Analyst Lynda Flower Clinical Analyst Elizabeth Wellner PMS & Billing Analyst Regina Pazarro PMS & Billing Analyst Sheldon Penner Software/Database Engineer 26

27. Process Workflow Patient Registration & Scheduling Patient Care & Health Records Billing & Payment 27

28. Clinical Decision Support Tools ORDER SET 30

29. Improve patient safety Improve quality of care Identify drug-drug interactions Identify drug allergies Increase patient compliance Improve patient self-care Meet Meaningful Use Clinical Decision Support Tools 31

30. Templates & Flowsheets Record & communicate care Create uniformity Ability to abstract data for research 32

31. Templates ADULT Diabetes Hypertension WOMEN Initial History & Physical Exam Trimester Assessments PEDIATRICS Preventive Health Upper Respiratory Infection 33

32. ADULT Asthma Obesity WOMEN Prenatal: blood pressure, fetal heart tones, etc. Preventive Care PEDIATRICS Age-Specific: body measurements, immunizations, developmental milestones Flowsheets 34

33. Increased patient satisfaction Timely access to current: Medications Lab results Patient education materials Email correspondence with physician Appointment requests Prescription refill requests Patient Portal 35

34. Modify post-EHR workflow as needed after go-live EHR clinical team Learn the application Assess what the system lacks for our needs Create gap analysis Next Steps 36

35. QUALITY ASSURANCE TEAM Metrics to track best practice protocols & business practices Practice protocols Meeting hemoglobin A1C goals for diabetics Peak flows for asthmatics Blood pressure control for hypertensive patients Business practices Patient wait times Percentage of physician CPOE utilization Meet Meaningful Use criteria Next Steps 37

36. CONTINUE RAND HEALTH’S PATIENT SATISFACTION QUESTIONNAIRE 18 questions completed after visit Paper option New online kiosk option Next Steps 38

37. Financial Process/Workflow Front & Back Office Workflow Coordination Interoperability / Coding & Billing Integration Documentation Payer-specific Requirements Processes E&M Calculator at point of care Data flow from system to system 39

38. PMS is utilized. - PSR schedules an appoint. - Demographics & Insurance info input into PMS PSR performs tasks in PMS: - Convert master ID to a patient Medical record #. - Updates, Collects Deposit/Co-Pay & payer information. Posts in PMS - Scans ID & insurance card. Patient is processed as per Adult patient Work-flow sheet. Billing Workflow & Medical Records/Abstracting Workflow - with EHR Practice Management System (PMS) in Place EOB scrutinized & if necessary chart is electronically pulled, notes sent electronically . Bill resubmitted or adjusted Bill reconciled A/R adjusted. - End Completes & confirms all provider orders then Flags orders as completed in EHR PSR PROVIDER BILLING NURSE NO Lab, Rad Pharm Bill paid? YES Patient checks in with PSR to verify Insurance or self-pay. If Self pay referred to social workers, etc. for Financial assistance. Using CPOE : - Orders & procedures are entered for auto processing into PMS - E&M calculator suggests OV level Chart reviewed for accuracy of codes & Documentation. Toward end of Patient encounter. Review & approves Abstracted & Scanned items Signs off paper chart Chart sent to Medical Records Code for billing & diagnosis from the PIS, RIS & Pharmacy auto migrates to PMS - Bill generated & checked for accuracy - Electronically submitted to insurance or patient Patient - List of Patients for next day is generated. Medical Records Add Pt name to “To be scanned” Worklog MR abstractor locates Record, scans, & abstracts for NEXT DAY Patients. - Patient records verified complete/approved. - Chart sent to long term storage. Abstracted Chart sent to PSR at Clinic. PSR Logs into PMS to review daily schedule. EHR automatically populated with schedule information. 40

39. Data Migration Strategy The Challenge Pre-populate the EHR with useful data day 1 145,000 annual patient visits Over 30+ years to be scanned & abstracted 41

40. Data Migration Strategy Solution for Existing Electronic Data Mirth Connect integration engine to develop channels between old & new databases Automate on-going data transfers: Updates, additions & deletions Solution for Paper Records Pre-Rollout: Migrate records of patients most likely to be seen soon Post-Rollout: Migrate records on a “go-forward” basis – patient who make appointments or appear at the clinic 42

41. Data Migration Table TYPE SOURCE METHOD TIMEFRAME Demographics PMS Bulk HL7 Interface Current Appointments PMS Bulk HL7 Interface Future Allergies Face Sheet Abstract Active Medications Face Sheet Bulk HL7 Interface / Abstract Current Problems Face sheet, PMS Bulk HL7 Interface Abstract Active Medical, surgical, family & social History Chart Abstract Current Measurements Chart Abstract Last 3 visits Lab results Outside Lab Lab, Chart Bulk HL7 Interface Last year Inside Lab Chart Bulk HL7 Interface Last year Procedures PMS, chart Bulk HL7 Interface Abstract Last year Therapies Chart Abstract Last year History & Physical Chart Scan Last Vaccinations Immunization Registry, Chart Bulk HL7 Interface Abstract Last given (includes all categories) Lifetime for children. Progress notes Chart Scan Last 3 visits Preventive & Health Screening Chart, Lab Abstract all. Scan any abnormalities 5 years Referrals Chart Abstract Active, all Goals Chart Abstract Last year Advance Directive Chart Abstract/scan Current Patient Education Chart Abstract Last year Flow sheets Chart Scan Last year Consultation/correspondence Chart Scan Last year / Active 43

42. Panel 3 - Hardware Operation Environment Individual Role Kal Shenoy Project Manager Chris Vu Hardware Engineer Michael Tegardine Network Engineer Josie Aguinaldo Security Administrator Ben de Rosales Jr. Software Engineer Thomas Hoffman Service Desk Manager Victor Cecena Desktop Manager 44

43. Implementation Strategy Current environment Network, Servers/Storage Applications, operations Upgrade plans Upgraded technical architecture Fiber Ring network Thin client deployments 45

44. Technical Architecture 46

45. Fiber Ring Topology Current T-1 connectivity Legacy copper connectivity at 1.544 MPS Fiber Ring Topology Providers: AT&T & Cox communications Why Cox Supporting Health Care providers Discussion of data/fact gathering with Sharp IT, & Family Health IT Fiber connectivity redundancy Dual connectivity from each router to Fiber ring Access & Security-High Level Patient/PHR-Web Portal IT support & Physician VPN & RSA/Token security 47

46. 48

47. Server Hardware - Location & Features Location Store in special server rooms, Central & East clinic (backup) Server Rooms Features Secure entrance Temperature controlled Redundant Power w/ Spike & Surge protection Monitoring – cameras, sensors Qualified staffs Server Hardware Features Intel Xeon processor – multiple processor RAID with hot swappable HD Redundant connections – multiple Ethernet / fiber ports Tape backup system 49

48. Server Software - Operating &Application Windows server 2008/R2 Standard, business, data center Features of server Operating Systems Robust – even during hardware failure Multiple security features including firewalls & intrusion detection Remote administration Extensive audit trail Special features of application servers & database Cache Clustering Virtualization (VMware) for development, demo, training, & QA Terminal services 50

49. Failover Clustering Key Benefits Protects against data loss & service interruptions Automates failover to reduced downtime, lower complexity of disaster recovery plan Reduces administrative overhead by automatically synchronize application & cluster changes, easier to keep consistent than unclustered servers Updating server without service interruption 51

50. Multi-site Clustering Key Benefits Protects against loss of an entire datacenter such as power outage, fire, hurricanes, floods, earthquakes, terrorisms Automates failover to reduced downtime, lower complexity of disaster recovery plan Reduces administrative overhead by automatically synchronize application & cluster changes, easier to keep consistent than unclustered servers Updating server without service interruption 52

51. Terminal Services Benefits Windows Server 2008/R2 Terminal Services gateway enables the creation of a scalable SSL-based remote access solution Terminal Services Session Broker enable the creation of simple & effective Load-balancing a terminal server farm 53

52. Software Installation Environments Non-production Development Quality Assurance (QA)/Test User Acceptance Testing (UAT) Demonstration Training Production 54

53. Infrastructure - Security & Privacy Password policy enhancements SSL Configuration Client Side certificates Audit Control Data Integrity HIPAA Compliant VPN Access – Two Factor Authentication (RSA Token) 55

54. Remote Access Provider can access EMR using VPN over the Internet 56

55. Workstation & Peripherals Thin Client Stations Work Stations Laptops Monitors Carts Printers All-in-Ones Peripherals 57

56. Computer Operations Service Support Service Desk Incident Management Client Surveys Service Delivery Service Level Management Service Level Agreements Production Review Board 58

57. Panel 4 - Software Aspects Individual Role David Montanez Project Manager Sheldon Penner Software/Database Engineer Ras Desimone Software/Database Engineer Laurelle Palmer Software/Database Engineer Warren Goldberg Risk, Regulation & Stakeholder Analysis Nga Anamosa Engineer Senior Analyst Jacqueline A. Harris Process Analyst Kal Shenoy Project Manager (Hardware) 59

58. Current System State 60

59. Future System State 61

60. Current Data Flow State 62

61. Future Data Flow State 63

62. OpenVista Install OpenVista & InterSystems Cache Convert & migrate sample patient data from PMS to OpenVista Support clinical team in system configuration tasks Test activated features of OpenVista & interface connections Test Health Information Exchange (HIE) connections... 64

63. InterSystems Cache OpenVista Database Selection InterSystems Cache Proprietary software Extension of MUMPS Graphical User Interface (GUI) interface Window, UNIX, Linux, Mac OS X, & Open VMS server High performance object database Web gateways access to web browser interface Rapid integration & development platform GT.M Open Source MUMPS language MUMPS database Linux & Unix operating system 65

64. OpenVista Database Advantages/Features Benefits 24 x 7 support Provides high comfort level to high-risk businesses such as medical clinics High performance - runs SQL 5x faster Uses multi-dimensional DB technology Scalability Enterprise Cache Protocol increases app performance VA uses it along with many other clinics & hospitals Stable product, continuously supported & upgraded On-line documentation & e-learning access Reduced cost to upgrade developer skills Multidimensional storage, journaling mgt., lock mgt. Tracks physical, logical DB updates; reduces conflicts between transactions trying to access same data Tools to work with it exist Supports Java, EJB, VB, .Net, etc. InterSystems Cache 66

65. Interoperability - Mirth & NHIN CONNECT Add OpenVista outbound & inbound channels Admit, Discharge, Transfer, Scheduling, Financial Transaction Create new inbound & outbound channels for Order Messages (ORM) & Order Results (ORU) Create new outbound channel to National Health Information Network (NHIN) CONNECT Gateway Create inbound & outbound Continuity of Care Record (CCR) & Continuity of Care Document (CCD) Install Cache Java Database Driver for the Mirth database reader Configure NHIN gateway connector in Mirth Test & deploy changes 67

66. Software Development Implement Rapid Prototyping Fits well into PDSA philosophy Application Lifecycle Management Microsoft Team Foundation Server 2010 OpenVista Patient Portal 68

67. Configuration Management Framework Identification Control Reporting Audit Benefits of Configuration Management Legal Obligations – Meaningful Use, HIPAA Process & approach Software Configuration Management Team Foundation Server 2010 Configuration Management Database Definitive Media Library 69

68. Configuration Management Manage changes to all Configuration Items in Production Server & network components, Software programs, Signed contract documents, etc. 70

69. Downtime Procedures GOAL CHC clinics remain operational during planned or unplanned events Plan is created/approved by internal committee METHOD Use approved paper methods to maintain workflow during downtime All paper records must be “back-chartered” into the electronic record in a timely fashion BOTTOM LINE Ensure downtime episode does not pose a threat to patient safety & integrity of clinical practice 71

70. Panel 5 - UAT, Training & Go Live Individual Role Eric Smith UAT Analyst Carmen Matthews Training Specialist Nga Anamosa Engineer Senior Analyst Laurelle Palmer Software/Database Engineer Lynda Flower Clinical Analyst Thomas Hoffman Service Desk Manager DeEtte Trubey Project Manager 72

71. User Acceptance Testing (UAT) Failure to conduct UAT will result in finding more problems after release. UAT should confirm whether the software supports the existing business process, not whether or not the software works. UAT will compare user expectation to actual results very early in the implementation. User requirements that evolve during UAT will be part of the post-EHR implementation. Key: Super-Users acceptance will influence community acceptance of the EHR. Steps for UAT Run Test Cases Mock-go Live Super-Users sign-off , Go-No Date(readiness for go-live) 73

72. Training Purpose (Why) Who, What, Where, How Effectiveness Afterwards – What’s Next 74

73. Training V1 75

74. Training V2 76

75. Project Monitoring & Control Data to be collected & reviewed during the implementation Meaningful Use Financial Return on Investment Quality Measures Compliance Patient Satisfaction Surveys Post Implementation Review Outstanding Issues Maintenance & Support 77

76. Panel 6 - Financial Impact Individual Role Keri Vogtmann Project Manager Luis Perez Clinical Analyst Carmen Valladolid Meaningful Use Analyst Sarah Leake Clinical Analyst 78

77. Meaningful Use Maximum Incentive Payment Amount for Medicaid Professionals Cap on Net Average Allowable Costs, per the HITECH Act 85% Allowed for Eligible Professionals Maximum Cumulative Incentive Over 6 - Year Period $25,000 in Year 1 for most professionals $21,250 $10,000 in Years 2-6 for most professionals $8,500 $63,750 $16,667 in Year 1 for pediatricians with a minimum 20% patient volume, but less than 30% patient volume, Medicaid patients $14,167 $6,667 in Years 2-6 for most professionals pediatricians with a minimum 20% patient volume, but less than 30% patient volume, Medicaid patients $5,667 $42,500 79

78. Meaningful Use Payment Scenarios for Medicaid EPs Who Begin Adoption in the First Year Calendar Year Medicaid EPs who Begin Adoption in: 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 80

79. Unpacking the “Meaningful Use” Requirements Major Components of Meaningful Use Proposed Rule & Recommendations Adoption Year Improve Quality, Safety & Efficiency Engage Patients & Families Improve Care Coordination Improve Population & Public Health Ensure Privacy & Security for PHI Stage 1 (2011) Achieve 80% CPOE 75% electronic submission of eRx Implement 5 clinical decision support rules Report quality measures to CMS/State Digitally Record Key patient data Provide Patients with electronic copy & access to health information within mandated time Provide clinical summaries for each office visit Exchange key clinical information among authorized care providers Perform medication reconciliation for 80% of all relevant encounters, transitions Submit data to immunization registries Provide electronic syndrome surveillance data Exchange key clinical information among authorized care providers Perform medication reconciliations for 80% of relevant care encounters, transitions Stage 2 (2013) Use CPOE for all orders Manage chronic conditions using patient lists & decision support Provide clinical decision support at the point or care (e.g. alerts, reminders) Ensure patient access to PHR populated with real time health data Produce & share electronic summary care record Reconcile medications between settings Receive health alerts from public health agencies Submit anonymized electronic syndrome surveillance data Ensure compliance with HIPAA privacy regulations Conduct or review a security risk analysis & implement security updates Stage 3 (2015) Establish medical device interoperability Develop multimedia support Implement clinical decision support for national high priority conditions Provide self-management tools Enable electronic reporting on care experience Access comprehensive patient data from all available sources Use epidemiologic data Share automated, real-time surveillance data Provide on-request accounting of treatment, payment & operations disclosure to patients 81

80. Meaningful Use Stage 1 Health Outcomes Policy Priority Objectives Metrics Collaborative Teams Throughout Meaningful Use Stages Improve quality, safety efficiency & reduce health disparities. (Objectives 1-16) CPOE; Drug-drug Interaction; Active problem list; e-RX; Active medication/allergy list; Demographics/vital signs & smoking status, incorporate lab test results into EHR, Generate lists of patients by specific conditions, Report ambulatory quality measures; Patient Reminders; 5 clinical decision support rules; Check insurance eligibility & submit claims electronically. Recording of structured data, Attestation, Generation of Reports, Electronic submission/transmittal, patient reminders Required percentage measures: 50%, 75%, 80% Physician & Nursing Staff, Medical Records Staff, Application Support Analyst, QU/MU Specialist Engage patients & families (Objectives 17-19) Provide patient with copy of electronic health information & clinical summaries within federally mandated time limit Access provided via patient portal or printed copy. Perform test of systems capability. Required percentage measures: 10% & 80% Mandated timeframes: 48 hrs., 96 hrs. Physician & Nursing Staff, Medical Records Staff. Improve care coordination (Objectives 20-22) Electronically exchange key clinical information among providers of care & patient authorized entities. Medication reconciliation. Medication reconciliation, clinical information exchange performed. Perform test of systems capability. Required percentage measure 80%. Physician & Nursing Staff, Medical Records Staff. Improve population & public health (Objectives 23-24) Submit electronic to immunization registries; Provide & transmit electronic surveillance data to public health agencies. Submit & transmit electronically to registries. Perform test of systems capability. Physician & Nursing Staff, QA/MU specialist. Ensure adequate privacy & security protection for PHI (Objective 25) Conduct & Review security risk analysis; Implement security updates as necessary; Ensure full compliance with HIPAA Privacy & Security Rules Conduct or review security risk analysis & implement security updates as necessary. Perform test of systems capability. IT Support/Security Officer Progress to Meeting Criteria 82

81. Procurement Plan Initial Understanding: HW, SW team needs Defined process Potential suppliers Budget for investment Vendor Evaluation Scorecard Criteria & weights Technology, quality, responsiveness, delivery, business, environment RFQs Delivery without negatively impacting go-live Tracking Spending & Performance 83

82. Major Expenditures Hardware Capital Expense = $330K Servers WAN SAN Fiber ring Thin clients High speed copiers Software Capital Expense (1st year) = $ 73K Elite licensing (80 to 115 users increase over 6 years) 84

83. Timing Go-Live Oct 2010 Training Nov-Dec 2010 Savings from Implementation Mar 2011 MU payments May 2011 Increased demand During Year 2012 85

84. Benefits MU Medicaid incentives ($3.5M) One time incentive 2011-2016 Transcription savings ($29K/mo) Increased number of visits: Labor efficiencies ($38K/mo) Word of mouth Riddance of flow charts, superbills, H&Ps, etc. & other administrative costs ($5-10K/mo) Reduction of labor costs ($18K/mo) Reduction of storage expenses 86

85. Cost Drivers Anticipate loss of productivity during training & initial deployment period Hardware $330K Software $73K first year $444K over 6 years Staffing $4M over 6 years 87

86. Staffing Assumptions Temporary 2 Trainers 2 Hardware Engineer Contractors 1 Contractor – OpenVista 4 Abstractors Backfill – MDs, RNPs, Nurses Permanent 1 Process Analyst 2 Technologists 1 Meaningful Use Specialist Providers Overtime Costs PSRs during training 88

87. Cost Breakdown 89

88. Cost & Benefits 90

89. NPV Analysis MU 100% MU 80% MU 60% MU 40% 8% $8.9M $8.7M $8.5M $8.2M 10% $7.8M $7.6M $7.4M $7.2M 12% $6.9M $6.7M $6.6M $6.4M 14% $6.1M $6.0M $5.8M $5.7M 16% $5.4M $5.3M $5.2M $5.1M IRR 5.8% 5.5% 5.1% 4.7% 91

90. Cumulative Cash Flows 92

91. What It’s All About 93

92. Additional Questions Thank You 94

93. UCSD Extensions HIT Spring 2010 Class 95 Name/URL E-Mail Josie Aguinaldo [email protected] Nga Anamosa [email protected] Victor Cecena [email protected] Ras Desimone [email protected] Lynda Flower [email protected] Jean Frazier [email protected] Warren Goldberg [email protected] Jackie Harris [email protected] Thomas B. Hoffman [email protected] Sarah Leake [email protected] Carmen Matthews [email protected] David Montanez [email protected] Mona Naoum [email protected] Laurelle Palmer [email protected]

94. UCSD Extensions HIT Spring 2010 Class 96 Name/URL E-Mail Sheldon Penner [email protected] Luis Perez [email protected] Regina Pizarro [email protected] Ben de Rosales, Jr. [email protected] Joel Salgado Jr. [email protected] Kallya Shenoy [email protected] Eric Smith Michael Tegardine [email protected] DeEtte Trubey [email protected] Carmen Valladolid [email protected] Keri Vogtmann [email protected] Thuan (Christopher) Vu [email protected] Elizabeth Wellner [email protected] Ann Winclair [email protected]