NNOHA HIT Committee White Paper Clinical Requirements Where did we start looking? ADA Take baby steps; Map out the sequence and hand-offs from patient entry to patient departure; “Walk a mile in my shoes”; see if your chosen software can conform to your methods of practice rather than the reverse

American Dental Association product evaluation survey :

NNOHA HIT Committee White Paper Clinical Requirements Where did we start looking? ADA CRA 2003 Take baby steps; Map out the sequence and hand-offs from patient entry to patient departure; “Walk a mile in my shoes”; see if your chosen software can conform to your methods of practice rather than the reverse

NNOHA HIT Committee White Paper Clinical Requirements High Level Requirements (outcome of our 1st Conf. Call on 4/2/08) User friendly Requires minimal staff training Intuitive Able to measure outcomes Able to assess quality of care being provided to patients

NNOHA HIT Committee White Paper Clinical Requirements High Level Requirements (continued) Able to measure productivity Billing Integrates records among sites that are geographically disparate Meets TJC (JCAHO) standards

Even without computers, our lives in the dental office are filled with stress…..

Example of each of our email submissions to choose the “Top 25” Requirements” (6/08) Appendix A: Starter Set of Functional Requirements for a Dental HIT System Using the American Dental Association product evaluation survey as a basis, the NNOHA HIT Committee members customized the requirements to more closely reflect the needs of safety net providers. These requirements were then used as the basis for a product evaluation of four dental products found in CHCs or expressing an interest in supporting this market segment. These requirements are offered as a starting point for oral health programs to use in their system selection process but they are not intended to be complete or inclusive of all organizational perspectives. Customizing and prioritizing the requirements to meet your organization’s needs are essential. Requirements that are particularly important to Health Centers have been noted with an asterisk. Appendix C contains the HIT Committee’s opinion of each vendor’s ability to meet key Health Center requirements. ** = Original choices for Top 25 * = My preferences for substitutes for items from Top 25 Usability and Navigation 1.01 Page forward and page backward functions are provided for multi page screens (data entry and display). 1.02 User interface provides a patient summary with a snapshot of all exams, notes, and treatments with dates. ** 1.03 The system has user-definable fields throughout the application that are fully reportable. * 1.04 Drop-down menus are available for data entry, progress notes, treatment plans with spell-check and choices displayed alphabetically or most frequently used. 1.05 User interface provides the ability to see the patient’s documents and digital radiograph scans and chart on one screen. 1.06 Hot Keys, buttons, and jumps advance from one part of a patient's file to another while retaining current patient when inside patient record. 1.07 Hot Keys, buttons, and jumps advance from one clinic location to another when in appointment scheduling mode. 1.08 Display and data entry screens for all applications accessed via functionally grouped menus and submenus. 1.09 System provides the ability to designate certain fields as required data entry fields that prevent the user from continuing until data is entered (e.g. PAIN ASSESSMENT; VITAL SIGNS). 1.10 Error detection/correction employed and smart data entry features available to enhance accuracy of data by editing date ranges, numeric vs. alphanumeric, valid number range, etc. 1.11 Document scanning of medical history automatically populates medical alerts including allergies, medications, and medical conditions from practice-defined medical history form template.

Health Center Dental Practice HIT Clinical Requirements (Final Version) 1. Usability and Navigation User-friendly, intuitive GUI (OMG!) 2. Training and Support Reliable, available 3. Care Management and Treatment Planning Integration of Information (Demographic, Financial, Health) 4. Tooth and Periodontal Charting

Health Center Dental Practice HIT Clinical Requirements (continued) 5. Productivity Measurement and Support 6. Billing Health Center payer mixes, multiple insurances, sliding fee scales 7. Integrates Records Among Sites that are Geographically Disparate Multiple locations capability 8. Meets The Joint Commission Standards (formerly JCAHO) Compliant with standards of health care (Pain Assessments, “Time Outs”, Prescription Database Medication Reconciliation) for Health Records

Now that you mention Pain Assessments…...

Health Center Dental Practice HIT Clinical Requirements (continued) 9. Imaging and Document Scanning 10. Integration with PM / EHR Systems HL7 Interface between EDR/EHR/EMR? Huh? One time entry for unduplicated financial and demographic documentation Sharing information such as medical alerts and medication histories Viewing appointment scheduling for maximizing reimbursement and coordination of care Remote access capability

Health Center Dental Practice HIT Clinical Requirements (continued) 11. Technical Requirements Connectivity between sites and servers Central or Local Server Location(s) Hardware Thin Clients versus Fat Clients Software On-site management or Off-site group networks Security & Privacy HIPAA/TJC Compliant Database Report functionality/creativity Built-in reports (UDS; field driven; appointment analysis) Exporting to 3rd party products (Access, Excel, Crystal Reports)

Health Center Dental Practice HIT Clinical Requirements Ask yourself: How are you practicing NOW with paper???? A picture says a 1000 words…. Photograph your office from: The patient’s perspective Each staff member’s perspective Can you duplicate electronically what you now are doing with pen and paper? It’s all about compromise…. There is no “perfect” software solution

NNOHA HIT Committee White Paper Clinical Requirements We drafted our report in July and….. Coincidentally, Gorden J. Christensen’s CR 2008 (July) Take baby steps; Map out the sequence and hand-offs from patient entry to patient departure; “Walk a mile in my shoes”; see if your chosen software can conform to your methods of practice rather than the reverse

NNOHA HIT Committee White Paper Clinical Requirements No matter what, we all need: Patients Our ‘external’ focus With an EDR, especially in the beginning, there is a need for: Patience Our ‘internal’ mantra Both are our “virtues”! We need BOTH to survive!

And speaking of patience, even without an EDR…..