MENTAL HEALTH & DADS CONTRACTOR EHR PLANNING MEETING May 25, 2011

2 EHR Planning Session #1 Early Planning

3 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? 4

5 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 6

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 7

Technology Readiness 8

9 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

10 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

11 Does Staff know what a computer is? Training capabilities Does Staff have the time? Redesign workflow Implement the system Validate results Repeat Technology Assessment

12 Comprehensive Cost Estimate Cost of System or Licensing Fees 3 rd Party Products and Services Annual Support Implementation Services Cost Hardware Internal Staff Project Manager Systems Analyst Database Administrator / Trainer Budget Considerations

13 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

14 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

15 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 16

17 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 & Hardware Extended Costs Database, 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, Enterprise Software System Costs

Implementation Extended 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, Enterprise Software System Costs

Internal Direct Costs Extended 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, Enterprise Software System Costs

Maintenance Extended Costs Annual maintenance contract$ 37,000 Annual internal maintenance cost$ 88,000 Total Annual On-Going Costs$ 125, Enterprise Software System Costs

22 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

23 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

24 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

25 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

26 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 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

27 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