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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
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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
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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
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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
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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
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Does Staff know what a computer is? Training capabilities
Does Staff have the time? Redesign workflow Implement the system Validate results Repeat
Technology Assessment
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Comprehensive Cost Estimate Cost of System or Licensing Fees 3rd Party Products and Services Annual Support Implementation Services Cost Hardware Internal Staff
Project Manager Systems Analyst Database Administrator / Trainer
Budget Considerations
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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
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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
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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
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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 & HardwareExtended
CostsDatabase, 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 $ 216,000
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Enterprise Software System Costs
ImplementationExtended
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 $ 213,000
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Enterprise Software System Costs
Internal Direct CostsExtended
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 $ 832,000
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Enterprise Software System Costs
MaintenanceExtended
Costs
Annual maintenance contract $ 37,000
Annual internal maintenance cost $ 88,000
Total Annual On-Going Costs $ 125,000
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Enterprise Software System Costs
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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
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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
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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
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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
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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. 08-10 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
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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