MENTAL HEALTH & DADS CONTRACTOR

EHR PLANNING MEETING

May 25, 2011

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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

Where Do You

Begin?

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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?

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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Technology Readiness

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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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Comprehensive 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

Costs &

Vendor Negotiations

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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

Software & HardwareExtended

CostsDatabase, 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

ImplementationExtended

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

Internal Direct CostsExtended

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

MaintenanceExtended

Costs

Annual maintenance contract $ 37,000

Annual internal maintenance cost $ 88,000

Total Annual On-Going 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 ongoing 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) of 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

office areas – meet frequently Be honest with yourselves

After The Contract Is Signed