EBR Labor Pains Donna Calabrese Director, Office of Vital Statistics Center for Health & Environmental Statistics Division of Health Kansas Department of Health & Environment

Why Update our EBR? In 2000, we began discussing and planning re-engineering our Vital Statistics system. In 2000, we began discussing and planning re-engineering our Vital Statistics system. –Birth registration topped the list »Using an antiquated DOS based system »Losing maintenance on outdated parts of the system of the system

Re-engineering Begins Re-engineering Begins Touched every facet of our electronic system: Touched every facet of our electronic system: –Registration of births, deaths, marriages, divorces, ITOPs –Amendments –Point of sale accounting system –Certificate issuance –Internal workflow system with queues and audit trail –Database conversion Incorporated certificate revision Incorporated certificate revision

Pre-Labor Pains Completed Needs Assessment Completed Needs Assessment Appointed Steering Committee Appointed Steering Committee Updated existing FileNet Imaging System Updated existing FileNet Imaging System Wrote RFP Wrote RFP Contract awarded in mid-2003 to ManTech Contract awarded in mid-2003 to ManTech

Contract Tips: Ownership of Materials Ownership of Materials Liability Liability Default Default Liquidated Damages Liquidated Damages Payment Payment –Payment for all accepted deliverables not to exceed 50% of total Project payments and payment for all completed and accepted phases not to exceed 50% or total project payments. Maintenance Maintenance –24/7 use of web-based system

Do Your Homework Do Your Homework Know what you want Know what you want –Conduct site visits to assess other state systems –Review NAPHSIS Use Cases and Artifacts –Meet with key office and IT staff »Review all desired functionality –Provide every detail possible to the vendor »Vendors do not know your business like you do Thoroughly read every design and data flow document Thoroughly read every design and data flow document –These documents are used to verify processes and functions throughout the entire project »Avoid change orders

Communication Communication Vendor Vendor –JAD Sessions –Conference Calls –Individual Calls, –Provision of hardware/software needs for external partners –Develop good rapport with agency IT Hospitals/Birthing Centers Hospitals/Birthing Centers –Sessions held re: certificate revision »Requested feedback »Provided information on web-based system –Letters with hardware/software requirements for new system »Projected impact of effect on processing –Contact state medical boards, associations »Articles in weekly, monthly publications

Heavy Labor Begins Heavy Labor Begins Time commitment is critical Time commitment is critical –Your own staff must be committed »Key staff with detailed knowledge of processes and functions A tremendous amount of time must be devoted to the re- engineering project – 60% of total time of key individuals. A tremendous amount of time must be devoted to the re- engineering project – 60% of total time of key individuals. –Your agency IT must be committed »Responsive and knowledgeable of project –Your vendor »Ask about resources committed to the project short and long term staff commitment short and long term staff commitment

Training & Pilot Testing Training & Pilot Testing Train the trainer sessions conducted by vendor Train the trainer sessions conducted by vendor Training sessions for pilot hospitals conducted by our staff Training sessions for pilot hospitals conducted by our staff –Selected 5 hospitals for pilot »Large, medium, small, city, rural »Testing conducted June, July 2004 Required dual entry Required dual entry –On-site training for 82 hospitals »1 and a half day sessions 1 st day – structured training; 2 nd day – practice on mock-up worksheets 1 st day – structured training; 2 nd day – practice on mock-up worksheets Hospitals continued pilot testing until Hospitals continued pilot testing until system implementation system implementation

Imminent Arrival Testing by office staff, IT, and hospitals Testing by office staff, IT, and hospitals –IT advanced test system date to ensure birth certificate numbering started correctly –Tested every function possible Planned for after-hours customer assistance Planned for after-hours customer assistance –Registration Chief and Field Rep on call –Determined vendor availability after hours –Determined IT availability after hours »Installed a third party software that checks server processes on window server (status change) Interruption in service Interruption in service CPU usage problem (overload) CPU usage problem (overload) Disc space Disc space Memory space (significant spike or none available) Memory space (significant spike or none available) »Most resolutions done by IT remotely On-site as necessary 24/7 On-site as necessary 24/7

The Delivery The Delivery IT’S AN EBR! IT’S AN EBR! –The system went live January 1, 2005 »All critical issues with birth registration were addressed first »Second priority was data exports (SSA, NCHS, internal partners, state partners) »Next, internal functions of amendments, adoptions, foreign born and delayed birth filings –Negotiated and compromised with vendor on priorities, deadlines, resources, fixes, and changes

Work With Your Vendor Develop and maintain a good working relationship Develop and maintain a good working relationship Be firm when necessary Be firm when necessary Negotiate when appropriate Negotiate when appropriate –Determine “bottom line” issues internally Document conversations, verbal agreements Document conversations, verbal agreements

Lessons Learned Lessons Learned Ensure design/functionality documents are updated throughout the project. Ensure design/functionality documents are updated throughout the project. –Require documentation of the completed system Watch carefully the ease and cost of making changes to certificate data, formats Watch carefully the ease and cost of making changes to certificate data, formats –Subject to legislative changes every year –Certificate revision –Other program changes (i.e., Newborn Hearing Screening, PRAMS, etc.) Stress importance of your office staff and agency IT carefully reviewing documentation and progress of the vendor. Stress importance of your office staff and agency IT carefully reviewing documentation and progress of the vendor. –Requires resource commitment