Feasibility Study

E H R LOGISTICSDescribe your co: EHR Logistics Inc is an electronic health vendor that provides a system that will reduce the amount of time healthcare providers and clinical staffs are spending recording patient information. The use of the EHR will allow immediate access to health records to help provide the best quality of care.

Describe company contracted to help: ABC Pediatrics is a group 3 physicians and 2 physician assistants. The group has three sites/locations within Arizona. They are a family medicine group that is currently using 100% paper for documentation and communication.

Describe project: The project will be a gradual transition into a web-based electronic health records system. The web-based system is a remotely hosted system with a secure server and HIPAA compliant. This type of system will reduce the amount of hardware/equipment upgrades needed because most computing is done on remote server. The use of EHR will lower cost, immediate access to records, automate and streamline workflow, and improve quality of care. The scope of the project will be fairly large because the company is transitioning from complete paper documentation.

Describe people involved: These members are important because the EHR would be part of their daily job duties/tasks. They know the current issues and needs of the group to specify what should be included in the EHR system. The members would be included in the planning/implementation of EHR because they work closely with physicians, patients, and medical records.

MEMBERS INVOLVED:

Project Manager:1. keep the project moving /monitor project to ensure all timelines are met2. delegate tasks to members of the implementation team3. maintain list of issues that need to be resolved4. communicate updates to the group/practice

Physician Champion:1. liaison between physicians within the group and implementation team2. point of reference regarding how things are done clinically3. keep physicians up-to-date on progress of HER

EHR Builder:1. build and customize EHR application (templates, drop-down boxes, auto

populate)2. communicate often with EHR vendor

Application Trainer:1. assist with training staff2. assist with building tasks

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Feasibility Study

Registration User:1. provide input for registration process

Billing User: 1. provide input for billing process

Medical Records User:1. provide input for medical records process

Technical Support:1. maintenance of EHR server(s) used2. running back-ups and upgrading system when/if needed3. assist vendor with maintaining and developing software/interfaces

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(5) Benefits realization: Stacey

Benefit Statement How EHR can help Before & After Metric

Save time for staff filing/searching for patient chart/records.

The chart will be accessible immediately for patient visit. The chart can be viewed in real time from all practice locations.

This saves time for locating/retrieving charts. The charts will not have to be carried to the different sites if the patient goes to different locations for office visits. Access to records between sites will be available immediately upon implementation.

Save time on writing and faxing prescriptions with the use of E-prescribing.

E-prescribing will allow the staff to submit prescriptions online.

The staff currently submits hand-written or faxed prescriptions. The prescriptions will go directly to the pharmacy and reduce the time staff spends calling/faxing. This will be available within 2 months of implementation.

Reduce the amount of shelves/space needed for filing charts.

The office will not have wasted shelves/space. This space can be utilized for additional patient rooms, waiting area, etc.

This will reduce the need to purge charges to make space and/or add additional space for charts. The 10 shelves will be removed from the office immediately after finalizing/reviewing scanned documents.

Save time on entering patient information for each visit.

The patient information is auto-populated for all appointments. The scheduler/receptionist just needs to verify with patient if there have been any changes (i.e. address, insurance, etc)

The staff will be able to save time and reduce errors if information is not entered for each visit, only updates when needed. There will not be a need to enter all new information for established patients. The use of this auto-populated information will be accessible immediately after implementation.

Reduce the turn-around-time for medical record requests.

Easily access records to be faxed/mailed upon receipt of request for medical records.

The records request can be completed within 24 hrs instead of the current 7 business days. Within the

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following 2 months of implementation the CD ROM and USB will be available.

(6) FEASIBILITY STUDY - Stacey

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Feasibility Study

1. EXECUTIVE SUMMARY

The use of an Electronic Health Records (HER) system will help improve the quality of care, assist with

organization within practice, and improve integration between providers. The EHR will assist with the

practices multiple site locations by making medical information readily accessible by providers. The

implementation of an EHR will provide both immediate and long term benefits for the practice.

2. BACKGROUND

The EHR system selected should be certified by the Certification Commission for Healthcare Information

Technology. The need of the EHR system for this practice is to save time, save cost, and quality

improvements. The practice should have the capability of immediate access of medical records for a

routine office visit and/or emergency visit. There should be a 24/7 Support or Help Desk Representative

available. Along with the implementation of the EHR system it should include routine upgrades in the

maintenance service fees.

3. SYSTEM OVERVIEW

The EHR system needs to be in compliance with Health Level 7 (HL7). This will make it easily accessible by

other provider groups and/or facilities. The use of EHR will allow multiple providers the ability to view

patient’s current/past medical history, registration information, medications, and labs/test results. The

benefits of the system would include improved claims/billing process, reduce cost in transcription,

additional office space, and eliminate lost/missing charts.

4. TECHNOLOGICAL FEASIBILITY

The EHR system should be developed to specifications needed within the practice. The practice will need

to train staff and providers to use the system. The vendor can provide a survey to current staff members

for daily job duties/activities to make the software specific. The practice would also need backup plans in

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the event of system outage/downtime. There can also be “workarounds” included in order for the system

to perform tasks that are not part of the initial application. In the event that there are questions by users

they software can include areas regarding:

frequently asked questions (FAQ)

term/quick reference

updates recently made to the system.

5. ORGANIZATIONAL FEASIBILITY

During the implementation and testing of the new EHR system there will be the need for new and/or re-

trained IT Dept Representatives. There needs to be access to Help Desk Services 24/7 or at least during

the hours of operations for employees. There will be a learning curve of employees during this time. By

employees having access to assistance with hardware/software issues is important in the practice’s

productivity. During this process there may be the need for temporary staff to assist with scanning all

paper records into the system initially. In some cases employees may also be required to cross-train for

more than one department within the practice.

6. FINANCIAL FEASIBILITY

EHR systems can be very expensive due to growing technology. The practice has to consider the best EHR

for their size and type of practice. The installation of new EHR system can initially cost the practice in

revenue and production. There is going to be expenses for operating and maintain the new software. The

time/money spent for training and future training will also affect the company. It’s important to determine

that this system is the best for the practice and not cause any financial struggle. The cost for

purchase/installation, ongoing training, maintenance, and support services should be considered.

7. SCHEDULE

Some of the steps in scheduling include:6

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Plan for conversion from paper records to EHR

Feedback from staff, physicians, IT Dept

Staff morale (how to handle resistance from employees regarding change, job security, and fear of

not performing up to standard)

Establish goals/expectations

Establish predetermined timeline to measure implementation

8. FINDINGS AND RECOMMENDATIONS

The results/findings include:

There needs to be a business and financial plan which include risks/benefits of new EHR.

Ensure that all of the practice needs are met before making a final decision on software/vendors(s).

The group/practice upper level managers should communicate with staff regarding the

reason/vision for the new system and discuss how it will better the company.

(7) Process Assessment: Patricia St.Pierre

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Feasibility Study

Process Type Function DescriptionThis is a manual

processScheduling and

Appointment RemindersAppointments are by patient’s calling in and front

desk entering appointmentFront Desk checks appointments and call reminders

24 hours before appointment.This is a manual

processRegistration Front desk checks insurance via calling companies

starting the day before the appointmentThis is a manual

processChart preparation Staff pulls the charts the day before and checks

insurance informationThis is a manual

processPatient arrival Information is rechecked by front desk with patient

then chart is given to M.A.This is a manual

processInitial exam M.A. enters findings and notes by hand into record

This is a manual process

Physician’s exam Physician enters all findings and notes by hand into record

This is a manual process

If there is lab work called for

The physician gives the record to the M.A. who carries it to the lab and gives it to the tech with the

lab order. Lab tech hand writes his results and places it into record. Tests that are sent out will be places in record after receiving them back for outside lab and

noted by the tech then reviewed by physicianThis is a manual

processMedication orders Hand written and given to patient

This is a manual process

Check out Patient goes to front desk and makes payment and if they need another appointment it can be made at

this point.This is a manual

processBilling and Coding Done in house and mailed out.

Reimbursements are entered by hand into computerThis is a manual

processOutside record retrieval

such as x-rays from hospital or inpatient records

They are couriered after verifying approval

This is a manual process

Record storage after use Staff replaces file into file storage

None Connectivity to record from remote location Hospital

etc.This is a manual Medication adverse effects Checked on-line

(8) NEEDS ASSESSMENT: Patricia St.Pierre

Techniques Used8

Feasibility Study

Survey of Staff and Physicians Study of other comparable offices Inventory of present materials and connectivity Administrative decision making safety issues

Resource Discoveries PrioritySurvey Medical record completely computerized

Access to records from remote locations Ability to retrieve medical records and test

results via computer from remote locations e-prescriptions and instant medication reaction

tags Direct connectivity to insurance providers for

billing purposes Computerized insurance verification program Computerized appointment reminder calls.

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Study Study of comparable offices: Both receiving comparable business flow Both receiving comparable income flow Both implementing E H R that facilities

ABC’s requests Report considerable saving in capital time

and a more complete and precise medical record

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Inventory The connectivity and technical components that are previously installed can be used with a new E H R system. They will be a need to allocate more components to double the existing ones.

This can be done within ABC’s budget.

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Administrative Decision The safety of the medical record is a priority.

With the new system the record will be more precise, clearer and more accessible.

The office will flow smoother and create a better environment for both patients and staff.

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(9) System Infrastructure Assessment – Vanita

SYSTEM INFRASTRUCTURE ASSESSMENTADDING MEMORY TO SUPPORT MORE COMPUTERS

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Feasibility Study

Component Current System Planned System Rationale/Explanation

Database Server

(Windows based with LAN interface and hardwire cabling)

Two redundant database servers

Dell Inspiron dual core

Use current servers with expanded memory

Expand current system to quad core.

Current database system is capable of handling the traffic for the planned system, but requires more memory to hold all the patient records.

The addition will also allow for more spending in other areas of the project, as we will have two more work stations added to the group.

Application Server Windows based Windows based We will be keeping the Windows based server because it fits our needs. You’re staff is well acquainted with the way it works and are accomplished in getting the best results with Windows. Changing will create disorganization and lead to inadequate service.

Web Server W.W.W. W.W.W. W.S.A. is too costly for now

Staff Workstations 1 COW/1desktop Keep the C.O.W. and desktops but add two laptops

We are adding laptops so that we will have mobility for the staff while they are doing their work. The nurse can note directly to the EHR. The C.O.W.s are unreliable and

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cumbersome. By adding the laptops we can leave the C.O.W. plunged in in the lab for use there. The addition will allow everyone a workstation.

Physician Workstations

Desktop(office) Keep office desktop but also use an added laptop & 5 iPhones for 3 physicians and 2 physician assistants

Having laptops in the examining room will allow the physicians to note directly into the EHR.

Peripheral Devices 2 printers 3 mice The devices will stay the same with 2 wireless mice added.

Adding the mice gives the laptop user a choice. Some find navigating a laptop easier and more efficient with a mouse.

Software Application(s)

Medisoft is leased/ Java/HTML

Medisoft is leased/ Java/HTML

electronic claims submissions & remittance postings, Productivity software, word processors, accounting database management, scheduling, email, collection letters Specialty software, encoders, Educational & Reference software, anatomy atlases, external articles, dictionary

These are functional for our needs. Leasing comes with a maintenance option which makes it less of a burden.

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Network LAN LAN This fits our needs. It is local and there is no need to change.

(10) SURVEYS (2): Stacey

Workflow Analysis

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Current Process Who performs each step? What steps are taken for process? What is the purpose of the process? What systems/tools used to perform

process?Efficiency

What works well for current process? What are challenges/difficulties with

current process?Impact

What impact do the challenges/difficulties cause for the practice?

Who is affected by the challenges/difficulties?

Suggestions for improvement Indicate changes that could improve current

process. How could new technology improve

process?Desired Outcome

What are some benefits of updating/changing process?

E H R Logistics Inc Practice/Location: ABC Pediatrics

Your Job Title ________________________ Date ___________

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Feasibility Study

Have you had prior experience outside of your facility with any electronic health records or computerized provider order entry systems? No____ Yes ____ If yes, about how many years of experience _______ Years working in healthcare

Would you rate your computer knowledge as below average; average; above average; advanced?_____________

Please indicate the extent to which you agree with the following regarding the EHR.Please check only one (1) response per item. Strongly Disagree Moderately Disagree Moderately Agree Strongly Agree

Strongly Moderately

Moderately Strongly

Agree Agree Disagree DisagreeThe electronic health record is consistently available.

The electronic health record is subject to frequent system problems.The electronic health record is user-friendly.

Sufficient support is available to use the electronic health record.The electronic health record features enable me to perform my work wellPatient care data being recorded is accurate and validPatients have concerns about the electronic health record security or confidentialityPatient care services are provided in a timely mannerThe electronic health record supports effective communication between most team members about patient careThe electronic health record contributes to the safety of patients

(11) Flowchart diagram Systems Comparison: Patricia St.Pierre

Systems Comparison

Old System New System

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Feasibility Study

Recommendation: Logistics can provide an E H R with the connectivity and versatility that ABC Pediatrics is looking for.

This will improve performance, increase capital flow, and create a safe working environment. This can be done within the timeframe and expense that ABC Pediatrics has contracted at.

(12) Cost benefit analysis – Carrie

COST BENEFIT ANALYSIS

Old System New System

Physicians back office

I-phone

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$M Year 1 Year 2 Year 3 Year 4 Year 5 TotalCostHardware 1.25 0.25 0.25 0.00 0.00 1.75Software 1.00 0.00 0.25 0.00 0.00 1.25Network Fees 0.15 0.15 0.15 0.15 0.20 0.80Installation and Training 0.50 0.10 0.00 0.00 0.00 0.60Maintenance 0.00 0.00 0.50 0.50 0.75 1.75Support 2.50 2.00 1.50 1.00 1.00 8.00MiscContingency Costs 0.10 0.00 0.00 0.00 0.00 0.10 Total 5.50 2.50 2.65 1.65 1.95 14.25BenefitsCharge Capture 0.10 0.25 0.55 1.25 1.75 3.90Decision Support 0.10 0.15 0.25 0.50 0.75 1.75Financial Management 0.25 0.25 0.25 0.25 0.25 1.25Reduce O.T. 0.10 0.15 0.20 0.25 0.75 1.45Cost Avoidance i.e. decr malpractice d/t improved quality & pt safety 0.05 0.15 0.20 0.25 0.25 0.90Decr storage costs 0.00 0.20 0.50 0.50 0.75 1.95Med Record Operations 0.50 1.00 2.00 3.00 5.00 11.50Referral Management 0.15 0.20 0.50 0.50 0.50 1.85 Total 1.25 2.35 4.45 6.50 10.00 24.55Net Impact -4.25 -0.15 1.80 4.85 8.05 10.30

(13) Training with rationale – Jackie

Train all super users and managers of each department-Let users become comfortable with use of the EHR Logistics system.

Hands on training within test environment for all super users16

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-The super user and trainees will build test patients, test diagnosis and test lab/result to train in a somewhat real patient chart.

Load one department at a time for feasibly training in a live environment -Rather than opening all of the departments we will manage one department at a time.

Go live after monitor of a single department being successful - Go live will mean all departments will perform job duties/tasks electronically in the EHR Logistics

system.

(14) Security Plans – Stacey

A security plan is needed to maximize the financial and productivity of the EHR System. The plan will accommodate the structure and needs of ABC Pediatrics. The use of an EHR allows easy access to a patient’s medical history which includes problem list, medications, lab results, and billing. A proper security will help to safeguard protected health information. The best practices used to assist in building a security plan:

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Protect hardware, third-party software, and EHR from security breaches with firewalls and anti-virus software.

Provide secure electronic communications with suppliers, patients, and pharmacies. Enable mobility through secure access to confidential documents from inside/outside practice.

A risk analysis will be conducted to help determine where security could be vulnerable both inside and outside of ABC Pediatrics by comparing current security measures to what is required to safeguard patient information. This will assist with questions regarding virus protection, evaluate firewalls, and secure e-communication. The security plan will consist of five components: administrative, physical, technical safeguards, policies and procedures; and organizational standards. Administrative safeguards would evaluate risk and enact policies/procedures to manage risks. This would include policies, established by an internal security official, to manage the development, implementation, and maintenance of security measures to protect PHI. Technical safeguards are used to monitor network and EHR capabilities in the most secure ways. This assists with monitoring use/access to information that a current/past employee is not authorized to view. The information should only be accessible based on need for job duties/tasks. In the event of technical support from source outside the office there should be a virtual private network used to access ABC Pediatrics system. Physical safeguards within the office are workstations, electronic information, and environmental hazards. This includes such measures as locking workstation when unattended, control access to areas with network servers, and secure documents in event of fire/inclement weather. The security official should include policies that states how often to back up the system to recover information so that it does not interrupt the work flow. It is important that a plan is in place for downtime in the event the systems and networks go down from time to time.

(15) Project Plan –Patricia

Project Plan For ABC Pediatric Clinic18

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Task Task Name Owner of Task Start

Duration End

1 E H R set up hardwareIT and electricians and E H

R Logistics 8/1/12 4 8/5/12

2 apply software E H R Logistics and clinic IT 8/3/12 2 8/5/12

3Test for systems connectivity E H R Logistics and clinic IT 8/5/12 2 8/7/12

4Train front desk staff training E H R Logistics and clinic IT 8/6/12 5

8/11/12

5Train billing staff training E H R Logistics and clinic IT 8/7/12 7

8/14/12

6 Management training E H R Logistics and clinic IT 8/2/12 148/16/1

2

7Run Check for accuracy of system E H R Logistics and clinic IT

8/18/12 1

8/19/12

8Run two week report of activity

E H R Logistics and management

8/18/12 1

8/19/12

9Analyze data for functionality

E H R Logistics and management

8/18/12 3

8/21/12

10 Revise if neededE H R Logistics and

management8/19/1

2 48/23/1

2Project goal is to have ABC Pediatric Clinic running on their new system within one

month.EHR Logistics will meet with the facilities management and IT departments

on 7/23/2012.

The purpose is train these departments on systems implementation and their rolls in it.

After systems go live EHR Logistics Help Desk will be available 24/7 via phone or on-line to troubleshoot any problems that may arise.

(16) Gantt Chart - Patricia

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GANTT CHART

(17) Project progress form – Carrie

PROJECT PROGRESS20

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TASKSTART DATE COMMENTS END DATE

Benefit Realization Study 8/1/2011 8/15/2011

Feasibility Study 8/30/2011 9/15/2011

Process Assessment 9/16/2011 Delay with clinic owners10/16/201

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Needs Assessment10/30/201

1Review Delay due to schedules

11/28/2011

System Infrastructure assessment 12/1/2011 Review with I.T.12/30/201

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Cost Benefit Analysis 1/5/2012 Schedule with owners mtg 2/15/2012

Training Plan 3/1/2012 3/30/2012

Final Approval Process 4/15/2012 5/30/2012

Training Implementation schedule 6/10/2012 Review PTO schedules 6/30/2012

EHR set up hardware 8/1/2012 8/5/2012

Apply software 8/3/2012 8/5/2012

Test for systems connectivity 8/5/2012 8/7/2012

Front desk staff training 8/6/2012 8/11/2012

Billing staff training 8/7/2012 8/14/2012

Management training 8/2/2012 8/16/2012

Run check for accuracy of system 8/18/2012 8/19/2012

Run two week report of activity 8/18/2012 8/19/2012

Analyze data for functionality 8/18/2012 8/21/2012

Review progress 8/22/2012 8/22/2012

(18) Backup Plans – Stacey

The backup will be completed by IT Dept member due to the use of a Windows based EHR system. The patient data will be saved in-house as well as backup-tapes stored off-site and protected in the event of malicious attacks, fire, natural disaster, and/or server theft. The group will have policies and procedures,

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employee training, and IT assistance to prevent unauthorized access to system data. The backup will be scheduled/completed daily every 4 hours via tape/hard drive). This will help to ensure that records are saved and available. The group will have policies and procedures, employee training, and IT assistance to prevent unauthorized access to system data. Members that are part of the backup plan should know their roles/duties in the event that there is an issue and the set time frame to complete tasks to have system functional. A backup plan is a very important part of the operation of a group/practice; loss of all data/patient records can greatly affect business. The plan will also include a backup for the system (i.e. CD, data entry template) itself. The backup data/system will be accessible to authorized persons and allow the group to process/work as normal (in remote location if needed due to natural disaster) until the system has been fully restored.

Contingency Plan

PurposeTo establish procedures that provides continued care for patients in the event of nonfunctional or improper function of EHR system during work hours.PolicyThe Contingency Plan is developed to reduce any negative effects/results due to system outage or improper function.Backup Plan

The assigned IT Department Manager/Lead will communicate with Office Manager, Physicians, and Lead Clinical Staff regarding length of expected downtime.

Scheduled downtime for maintenance/updates will be communicated in advance with managers who will then notify departments regarding date/time.

Unscheduled downtime occurring due to software/hardware issues will be communicated between assigned IT Department Manager/Lead and Office Managers/Physicians. The Lead Clinical Staff will notify and provide staff with estimated downtime and implementation of plan/procedures.

ProceduresDowntime over 1 hour:

The practice staff will complete job tasks/duties in the manner before EHR system was implemented. Registration/Payments completed on paper documents and later entered in system. Encounter forms completed manually and later entered in system. Lab/Test orders completed on paper request documents and results called/delivered.

Restoration: All future visits completed in EHR system and current or in progress visits completed in EHR system. Staff to enter tasks/procedures (i.e. office visit, prescriptions, labs, scheduled appointments) performed during

outage in EHR System.

***Website Development (Weebly)– Vanita/Patricia***

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