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Cuyahoga County Board of Health (CCBH) and Regional Extension Center (REC)
James W Coates, MS, RSResearcher, Epidemiology, Surveillance and Informatics
Cuyahoga County Board of Health
• Serves ~845,000 residents in Cuyahoga County, Ohio excluding the City of Cleveland and Shaker Heights.
Why EHR at LHD?• Participate in the Health Information Exchange
• Provide Patient Data • Get Population Data
• Increase Revenue• Improve Productivity and Efficiency• Improve Customer Service and Quality of Care• Improve Regulatory Compliance
Keys to Success• Senior-level Management Support
• Funding, priority setting, and executive attention• Physician and Nurse/Staff buy-in
• Identify Champions• Abandon inefficient processes• Leave the “we’ve always done it that way” behind
• Maintain Constant Communication• Understand Technology alone will not transform nursing practice
Liang, L. Connected for Health Using Electronic Health Records to Transform Care Delivery. 2010. Jossey-Bass A Wiley Imprint.
Goal
To record all patient interactions, migrate historical data from current practice management (PM) system, track and generate claims, achieve stage 1 meaningful use, participate in the State health information exchange, and comply with HIPAA 5010 and ICD-10 requirements.
CMS Incentive Flow Chart
Centers for Medicare & Medicaid Services. ICN# 905343 (September 2010) https://www.cms.gov/MLNProducts/Downloads/Eligibility_Flow_Chart-ICN905343.pdf
History of Events• October 2010
• REC Kick-off Meeting• Not Eligible for REC Services
• November 2010• Title X Letter
• December 2010• Signed REC Agreements
Golden Ticket
*Additionally CCBH contracts with Certified Nurse Midwife with prescriptive authority and a M.D.
REC Experiences• Case Western Reserve University (CWRU)
• Assigned Consultant• Welch Allyn
• Preparation Questions• Personnel • Budget• Work flows
Welch Allyn• Preparation Questions
• Personnel
• Budget
• Work flows
CCBH Direct Services• Immunizations
• Child• Adult• Travel
• Title X Family Planning• School Based Dental Sealant
Work Flows• Documents sequence of events between actor and the
system.• Excellent learning experience for all• Communicates needs to developers• Essential for developers
Example Work Flow
Orlova, A., Johns Hopkins University, Health Information Technology Standards and Systems Interoperability Course, Spring 2011. http://ocw.jhsph.edu/courses/infstandards/PDF/infStandards_lec5c_orlova.pdf
Fork in the Road• System Type
• Integrated• Include Case Management
• Interfaced• Could Include Case Management
Case Management• Things to consider
• Include in build out of EHR• Comprehensive System
• Reporting• Maintenance
• Cost
Next Steps• Case Management?• Develop RFP• Evaluate Vendors• Vendor Selection
Timeline
Welch Allyn Process {Deliverable: Requirement Analysis Document}|----------------------------|
_______________________________________________________________________________ Jun-11 Aug-11 Apr-12 May-12 Jul-12 Sept-12 Nov-12
Sys. Development {Deliverable 1: Sys. Development Specifications}|----------------------------| {Deliverable 2: Working prototype / pilot}
Modification|------| |---|
Implementation {D: Sys. Documentation}|-------------------------|
Evaluation & Operation {D: Ops. Manual} |------------------------------->
Send out RFP {Deliverable: Receive at least 3 proposals}|----------|
Vendor Selection {Deliverable: Choose 1 certified vendor}|----------|
Pilot testing & retesting {D: Pilot Testing Protocol/Report} |---| |-----|
Contact InformationJames Coates, MS, RSResearcherEpidemiology, Surveillance and InformaticsCuyahoga County Board Of Health5550 Venture DriveParma, OH 44130Phone: 216-201-2001 ext: 1617Email: [email protected]
