adoption and use of electronic medical records (in federally qualified health centers) and...

Adoption and Use of Electronic Medical Records (in Federally

Qualified Health Centers)and Supporting an ASP

Community Care Network of Virginia, Inc.

Outline

• Who is Community Care Network of Virginia (“CCNV”)• Technology Goals

• Efficient and Productive Use of EMR• Center for Data and Informatics – Quality• Medical Home and Health Information Exchange• Innovation

• eClinicalWorks Deployment• ASP Hosting• ASP Architecture• Challenges and Benefits

Disclaimer

Community Care Network of Virginia (CCNV)

• Provider Network Incorporated in 1996

• Owned by all of Virginia’s 24 Federally Qualified Health Centers

• Located in 90 sites across the Commonwealth

• 300 providers delivering primary care, dental and behavioral health services

Federally Qualified Health Centers

• Independent non-profit corporations• Mission to serve all members of a community

regardless of patient’s ability to pay• Operate in local communities• Over 1,200 across the country • Take most if not all third party insurances• Receive limited Federal grant dollars to cover the

cost of serving the uninsured• Commitment to quality

CCNV Business Purposes

1. Represent providers/practices in third party payer contracting - single signature authority

2. Provide cost effective management services information technology, medical and dental billing, NCQA certified provider credentialing, etc.

3. Performance Improvement – Center for Data and Informatics

CCNV Technology Goals

Goal 1: Efficient and Productive Use of EMR

• Shared purchase pricing• Multiple hosting options• Readiness evaluations • Workflow analysis and improvement• Training, training, and more training• Central support and ticket management• User group on line forums and twice yearly

meetings

Goal 2: Center for Data and Informatics

• Establishing clinical outcome measures

• Collection and aggregation of data

• Establishing data validity and reliability

• Reporting and benchmarking

• Network and local performance improvement activities

• Quality forums

Goal 3: The Medical Home and Health Information Exchange

Medical Home [Federally Qualified Health Center]

Specialists

Hospitals

Pharmacy Hospice

Payers

Home Health

Local Social Service

Agencies

Medical Home and HIE

Health Department

Labs

Patients

Goal 4: Innovation KIOSKS

• Network wide initiative to fabricate and install waiting room KIOSKS

• Kiosk content integrated into EMR in real time immediately prior to patient entering exam room

• Initial content limited to behavioral health assessment (PHQ-2 and PHQ-9)

• Additional content and functions over time• Streamlines total patient time in the office

eClinicalWorks Deployment

eClinicalWorks (eCW) Deployment

• Two year due diligence planning period• Negotiated network purchase agreement• Licenses owned by individual health center• Optional hosting infrastructure (individually or

ASP)• Master implementation schedule based on

individual organization readiness• Network based, eCW certified trainer and support

technician

ASP Hosting

ASP Hosting

• ASP hosting is optional• Our model is client owned not vendor owned• Software vendor accommodates both ASP

individually hosted architecture• Reasons for choosing ASP vary

• Small practices with limited capital resources and staff

• Large practices not wanting to make significant hardware investments

• timing

ASP Architecture

ASP Architecture

• Located in hosting facility in Richmond

• Corporate office approximately 6 miles from hosting facility

• Hosting facility secure, redundant systems, on site technical staff can provide optional services

ASP Architecture

• Currently have 14 servers• 15 out of 20 organizations are hosted• Currently installed in a single rack• Server types - application, data base, document

management, reporting• Fax servers hosted locally• All servers and drive configurations are redundant• All sites connect through VPN to data center• eCW software manages server\data access

ASP Architecture

• Local engineering support is outsourced

• Central (CCNV) help desk for triage of problems

• eCW handles all software issues

• Set weekly coordination and management calls with eCW

Challenges and Benefits

of an

ASP

Challenges and Benefits

• Internet connectivity issues• Hardware upgrades driven by growth, vendor specs, new

technology (virtualization), maintenance replacements• Lease vs. buy• Must have good communications with vendor (eCW) in

order to manage software upgrades and fixes• Individual practice growth must be accommodated by the

ASP• Technical Staffing and Support relationships are local and

long term• Troubleshooting centers on connectivity and performance

(latency) issues

Challenges and Benefits

• Eliminates human resources issues for practice• Technical expertise available to individual

practices that they might otherwise not have access to, or can afford

• The number and types of issues experienced by a large practice that individually hosts are similar to an ASP hosted configuration

• Most issues are not eliminated, the responsibility to address them are shifted

David SeligChief Executive Officer

Community Care Network of Virginia6802 Paragon Place

Suite 630Richmond, VA 23230

804-237-7686dselig@ccnva.com