Electronic Medical Record/Practice Management Evaluation Project

State: NC Type: Model Practice Year: 2010

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Local public health departments in the North Carolina southern piedmont region (and throughout the state) use a paper-based medical record system and are not able to electronically exchange medical record information with community healthcare providers or a health information exchange (HIE) to improve access to comprehensive patient health data and care coordination.

The goal of the EMR/Practice Management Evaluation project is to have public health electronically communicate with a regional HIE, community healthcare partners and consumers to improve access to comprehensive patient health data, to engage patients and their families in their healthcare, and to improve care coordination. Since NC public health has a paper-based health record system, there was a critical need to analyze practice management, clinical assessment, and case management business processes for all areas that would be affected by an EMR in order to describe what an information system must do to support the tasks and interface with an HIE. The Public Health Informatics Institute’s (PHII) Collaborative Requirements Development Methodology helped us define our EMR and Practice Management needs and evaluate software applications. We hope by sharing our experience spent over 18 months on our EMR/Practice Management evaluation project, other public health departments will see how the Collaborative Requirements Development Methodology should be used for process improvement and any type of information system analysis and development in public health.

1. Participants learned the skills of business process analysis and the benefits of collaboration in planning and refining business processes.

2. Developed requirements to better assess which EMR/Practice Management solution best met each health departments needs.

3. Developed evaluation tools for subject matter experts (SME) to score each vendor solution.

4. Afforded each health department to make a knowledgeable decision in selecting an EMR/Practice Management system.

5. Assisted all health departments in North Carolina by determining future enhancements needed for the state system.

6. The business process documentation has a multitude of uses. For example the task flow diagrams are a great learning tool for new employees and reference material for managers of how a business process is done and what role various entities play. Details about the necessity of the task and who performs it are uncovered.

7. Opportunity for SME's to learn from other health departments approach to business processes.

By collaborating with SME's from other health departments, some business processes were able to be refined immediately to be more efficient and effective.

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Public Health Authority of Cabarrus County
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Electronic Medical Record/Practice Management Evaluation Project
Local public health departments in the North Carolina southern piedmont region (and throughout the state) use a paper-based medical record system and are not able to electronically exchange medical record information with community healthcare providers or a health information exchange (HIE) to improve access to comprehensive patient health data and care coordination. The goal of the EMR/Practice Management Evaluation project is to have public health electronically communicate with a regional HIE, community healthcare partners and consumers to improve access to comprehensive patient health data, to engage patients and their families in their healthcare, and to improve care coordination. Since NC public health has a paper-based health record system, there was a critical need to analyze practice management, clinical assessment, and case management business processes for all areas that would be affected by an EMR in order to describe what an information system must do to support the tasks and interface with an HIE. The Public Health Informatics Institute’s (PHII) Collaborative Requirements Development Methodology helped us define our EMR and Practice Management needs and evaluate software applications. We hope by sharing our experience spent over 18 months on our EMR/Practice Management evaluation project, other public health departments will see how the Collaborative Requirements Development Methodology should be used for process improvement and any type of information system analysis and development in public health. 1. Participants learned the skills of business process analysis and the benefits of collaboration in planning and refining business processes. 2. Developed requirements to better assess which EMR/Practice Management solution best met each health departments needs. 3. Developed evaluation tools for subject matter experts (SME) to score each vendor solution. 4. Afforded each health department to make a knowledgeable decision in selecting an EMR/Practice Management system. 5. Assisted all health departments in North Carolina by determining future enhancements needed for the state system. 6. The business process documentation has a multitude of uses. For example the task flow diagrams are a great learning tool for new employees and reference material for managers of how a business process is done and what role various entities play. Details about the necessity of the task and who performs it are uncovered. 7. Opportunity for SME's to learn from other health departments approach to business processes. By collaborating with SME's from other health departments, some business processes were able to be refined immediately to be more efficient and effective.
The overall goal for Common Ground from the Robert Wood Johnson Foundation is to improve the health of citizens through the improvements in services, especially service improvements driven by better use of information systems. Public health agencies are struggling to develop adequate information systems. Many times when state and local public health agencies develop or purchase information systems, they do not collaborate or take into consideration other systems, departments or community partners they may need to share information with or the affect that their information system may have on others. Many, if not most, public health information systems are not interoperable with other systems within the agency or state and therefore information silos are created. Typically information systems take twice as long and cost twice as much as originally anticipated. Modifications to an information system that should have detailed specifications based on analysis prior to development or acquisition can cost 10 times as much to develop and incorporate into the application after the system has been developed. Quality improvement work involves examining your business processes.Sometimes it involves information technology and sometimes it doesn’t. It is important to organize the workflow to take advantage of the capabilities of an information system. Information systems exist to facilitate the work of an organization. Because of limited public health funding, working collaboratively among departments, other agencies and community partners optimizes the use of resources. Ultimately with improved, well-understood processes and information systems that support them, public health agencies will have improved services, more timely responses, and potential for reduced cost. The benefits of collaborating and using the Collaborative Development Requirements Methodology include: • Common vocabulary and definitions are established.• Better understanding of processes, especially those that IT will support. • Improve processes by learning how other health departments and community partners approach a business process. • By collaborating with entities involved, the planning, implementation, and operation of a business process is easier and more accepted. • Facilitates development of requirements. • Focuses on interoperability between systems. • By having a common set of requirements, software vendor’s interest in developing applications for public health increases because there is a wider audience interested in the application versus a custom application for each health department. It is also likely that it will cost less to deploy a system since it is not customized. In the end, an organization should be able to express to a software vendor, the IT department, or the Department of Public Health exactly what a new IT system needs to do. An organization should be able to get a system that works the way you want to work, not the way that it makes you work.1. This project is described in a chapter of a book released in 2009 called The Public Health Enterprise: A Guide to Management, “Business Process Improvement…Working Smarter Not Harder." Prior to using this methodology to determine what was needed in a new software application, half of the requirements were determined from what the current system did and the other half of the requirements were determined by evaluating what the software applications did, sometimes being swayed by the bells and whistles of a solution. Because public health has not been in the business of focusing on improving business processes that involve information systems, the public health workforce is lacking in this expertise. In general, requirements were not formally tracked and there was not a good way of evaluating what our needs were and how that matched the applications being considered. By collaborating with several other health departments, we are able to determine or reinfor
Agency Community RolesAs part of the Common Ground goals, the Cabarrus Health Alliance trained over 100 public health leaders in the southern piedmont region in the skills of business process analysis and the benefits of collaboration in planning and refining business processes. The Cabarrus Health Alliance led the EMR/Practice Management Evaluation project, coordinated with the eight public health departments involved and managed the activities of the project. Over 60 subject matter experts from eight health departments and consultants from the North Carolina Department of Public Health collaboratively analyzed and redesigned 46 business processes, developed 680 requirements and over 4,000 data fields for the following areas: Billing, Child Health, Child Services Coordination, Communicable Disease, Family Planning, Intensive Home Visiting, Lab, Maternal Care Coordination, Maternal Health, and Registration/Checkout. Understanding the business processes allowed the team to develop well-defined requirements and be very knowledgeable when evaluating EMR/Practice Management systems. Costs and ExpendituresIn December 2006, the Cabarrus Health Alliance was awarded a $600,000 three-year grant from the Robert Wood Johnson Foundation called Common Ground: Transforming Public Health Information Systems. The Cabarrus Health Alliance is the lead agency in the Southern Piedmont Partnership for Public Health (SPPPH), a public health incubator comprised of 11 area North Carolina local health departments that work collaboratively together to share experiences and resources and implement innovative capacity building and prevention initiatives. Representatives from eight of the health departments participated in the EMR/Practice Management Evaluation project which was funded partially by the Common Ground grant. Approximately 50% of staff time was donated as in-kind to the project by each health department. Project management was paid by the grant. ImplementationAfter the three EMR/Practice Management solutions were evaluated, each health department was able to make a sound decision in selecting an EMR/Practice Management system. The results from the project have been shared with many health departments in the state, and many have utilized the work that we have done to select an EMR/Practice Management vendor that meets their needs. Specifically for the Cabarrus Health Alliance, a recommendation was made to the board in December, it was approved, and a contract was signed with our selected vendor. Due to detailed analysis and evaluation of their solution against our requirements, we were able to define what enhancements needed to be made to the product. This included the development of an entirely new module. The vendor is thrilled to work with a client who knows exactly what they need and has the information to support it. The vendor will be able to share our enhancements with their other customers as well as sell the new module being developed. We have also been seen by the vendor as a key client that will be utilized in the future for determining roadmaps of the product. Our next project is the EMR/Practice Management Implementation project. We plan to go-live with the new system with the registration/checkout and billing areas first and then rollout the other parts of the system to the clinical and case management departments over the next few months. Detailed project plans have been created to aid in a smooth transition from our paper-based medical record system to an EMR. A project team has been created that meets weekly to assist with the project plans. Quality improvement measurements for efficiency, effectiveness, workload, and capacity will be captured before and after implementation. Reviews of our EMR/Practice Management Evaluation project from many sources (i.e. software vendors, IT consultants, and other healthcare agencies) who have deployed EMR systems indicate that the work that was done upfront to analyze the business processes, define the requirements and evaluate solutions will save us significant amounts of time and resources during implementation because we already know what we need. We plan on measuring and reporting our results. We plan to go-live with the new system with the registration/checkout and billing areas in June and then rollout the system to the clinical and case management departments over the next few months. We hope to have all departments live by the end of September. There will be continuous business process analysis and requirements definition as the new system is used. The EMR/Practice Management system will become a key player in the activities of the health department and enhancements to the system will continuously be made.
The goal of the EMR/Practice Management Evaluation project is to have public health electronically communicate with a regional HIE, community healthcare partners and consumers to improve access to comprehensive patient health data, to engage patients and their families in their healthcare, and to improve care coordination.Analyze practice management, clinical assessment, and case management business processes for all departments/areas that would be affected by an EMR and make efficiency and effectiveness improvements where possible.Business Process Analysis & Redesign– Developed business process matrix, context diagrams, and task flow diagrams for 46 business processes with 60 subject matter experts from eight public health departments. The business process analysis tools assisted the project team in collecting information about the goals, objectives, business rules, triggers, inputs, outputs, outcomes, tasks, and transactions of each business process.Held 48 in-person workgroup meetings that were at least four hours in length and primarily located at the Cabarrus Health Alliance to analyze and redesign 46 business processes from March – October 2008.Local and State Public Health Departments and Software vendors - All phases of work from this project and the evaluation results are available at www.cabarrushealth.org/commonground. Long Term - Participants learned the skills of business process analysis and the benefits of collaboration in planning and refining business processes. Unintended - Opportunity for SME's to learn from other health departments approach to business processes. By collaborating with SME's from other health departments, some business processes were able to be refined immediately to be more efficient and effective. Unintended - The business process documentation has a multitude of uses. For example the task flow diagrams are a great learning tool for new employees and reference material for managers of how a business process is done and what role various entities play. Details about the necessity of the task and who performs it are uncovered. Describe and define what an EMR/Practice Management system must do to support the public health practice management, clinical assessment, and case management tasks and interface with an HIE. Requirements Definition – Defined 680 functional and technical requirements and defined over 4000 data fields with 42 subject matter experts from three public health departments.Data fields from practice management, clinical assessment and case management forms were collected by the project team members from forms used in the business processes analyzed. Requirements were captured utilizing the task flow diagrams, context diagrams and business process matrix.Held 32 in-person workgroup meetings that were at least four hours in length and primarily located at the Cabarrus Health Alliance to define functional and technical requirements from January - June 2009.Local and State Public Health Departments and Software vendors - All phases of work from this project and the evaluation results are available at www.cabarrushealth.org/commonground.Intermediate term - Developed requirements to better assess which EMR/Practice Management solution best met each health departments needs. Evaluate software applications based on the defined EMR/Practice Management needs.Evaluation – Developed six use cases and a scoring method to evaluated three EMR/Practice Management solutions from different vendors with 32 subject matter experts from three public health departments. Through demonstrations by different EMR/Practice Management vendors, the project team was able to score the solutions abilities for each requirement and data field defined.Held 8 in-person demonstration and evaluation meetings that were at least six hours in length and primarily located at the Cabarrus Health Alliance to evaluate EMR/Practice Management solutions from July – October 2009.Local and State Public Health Depa
In addition to a new EMR/Practice Management system, the Cabarrus Health Alliance is in need of a new finance, payroll, and human resource system. This new system will have a significant effect on all departments in the health agency. The success of the EMR/Practice Management Evaluation project has sufficiently convinced the senior management staff of the importance of this best practice approach. The commitment to this process is best acknowledged by the fact that the project management position hired for the Common Ground project and paid by Common Ground funds was deemed a necessary position to budget for by the agency.
 
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