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Electronic Health Record Solutions to Provide Great Care Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director, GO CARE Mandy Kastner, MPH Director of Quality Assurance, ARCW

Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

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Page 1: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Electronic Health Record Solutions to Provide Great Care

Mike Gifford, MBAPresident & CEO, ARCW

Anna Wuerth, MSW, LISW-SDirector of Healthcare Operations, ARC

Ohio

Richard Womack, MSW, LCSWExecutive Director, GO CARE

Mandy Kastner, MPHDirector of Quality Assurance, ARCW

Page 2: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Market Forces Driving EHR

Mike Gifford, MBAPresident and Chief Executive OfficerAIDS Resource Center of Wisconsin

Page 3: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

The ‘new’ leading care delivery system

HIV patients’ needs go well beyond HIV

Many sources of data (lab, pharmacy, specialty care)

Patient contact information can change frequently

All care needs to be documented in one system & available to all providing care

Integrated Care

Page 4: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Greater patient choice Greater efficiency in registering and

caring for patients Automated communication with

patients Patient involvement in care greatly

expanding

Patient Experience

Page 5: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Focus on quantity is diminishing Focus on quality is expanding Easy access to data for process

improvement Funding tied to quality outcomes Accreditation and recognition may be

tied to EHR Quality applications for EHRs may be

within the system or an overlay

Quality Outcomes

Page 6: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Federal appropriations level at best Private funding challenged by new

and different priorities ACA drives changes in public funding Reimbursement funding is the future Payment tied to quality outcomes

Funding

Page 7: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Perspectives on EHR from AIDS Resource Center Ohio

Anna Wuerth, MSW, LISW-SDirector of Healthcare OperationsAIDS Resource Center Ohio

Page 8: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

FY16 Annual Budget: $44 million • 6 times our post-merger budget 4 years ago

13 offices in 10 cities 220 staff

• 3 times as many staff as post-merger 4 years ago Providing medical care to roughly 1,400 patients Assisting more than 5,000 HIV-positive individuals with

services such as case management, behavioral health therapy, housing assistance, medical care and pharmacy services

Reaching more than 25,000 with community education, evidenced based prevention interventions and free HIV testing

AIDS Resource Center OhioTransformations Post 2011 Merger

Page 9: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Identified Organization’s Top 3 Requirements of an EHR: Implementation Speed

• ARC Ohio Board of Directors Vote to Open a Medical Center and Pharmacy: Winter 2012

• Opening Day: October 2012 (Only 8 months of planning time for ALL clinic/pharmacy opening activities!)

Cost of Service• Needed something affordable

Comprehensive Service Options • Billing, scheduling and electronic health record

Electronic Health Record Rollout In a New Clinic

Page 10: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

CareCloud

Page 11: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

CareCloud- Cloud Based System

Strengths Fulfilled our day-one

opening needs for necessary billing and charting activities

Provider progress note templates easily adaptable

Basic data was retrievable in excel format reports

Simple to use and learn Web-based, requiring very

little IT support prior to implementation

Weaknesses Was essentially a “paper

chart” in an electronic format

Costly to establish lab interface

No onsite go-live support Limited clinical decision

making support Task routing very limited Monthly cost increased

significantly over 2 year period

Page 12: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Carecloud viewed as short-term solution Clinical workflows and decision making

support inadequate ARC Ohio clinic #2 planning discussions

began after year 1 of operations—marked ideal transition timing

Partnership exploration identified beneficial options

Sought a more robust system

Decision to Change EHRs

Page 13: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Premier Health: Access to Epic

Page 14: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Robust system Extensive onsite go-live

support Clinical decision making

support Improved workflow Part of larger provider

network Improved reporting

capabilities More advanced billing capabilities Well organized chart

Epic

Page 15: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Premier Health not as advanced as some other Epic Vendors

Requests for changes or fixes are fulfilled slowly

Lack of report related training available to staff ARC Ohio one of first clinic settings to need

such extensive reports Premier Health had not fully implemented two-

way reminder call/text features Not willing to develop interfaces

Not All Epic Vendors Are Created Equal

Page 16: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Multiple systems fed into one creates thorough patient profiles

Quality/data team use data imports

Used for Ryan White related reporting

Clunky system

CAREWare

Page 17: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Interview a variety of vendors and explore demos in depth. Involve ALL necessary staff in selection process (finance,

data, IT, providers, etc.) Contact references and visit clinic sites to see the EHR in

action. Must understand reporting capabilities of system, vendor’s

report development process as well as the methods of data extraction.

Federally Qualified Health Centers (FQHC) have special reporting requirements and billing needs. • Must explore these considerations prior to committing to a

system and a vendor. TRY NOT TO RUSH THE SELECTION PROCESS.

Closing Considerations

Page 18: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Anna Wuerth, MSW, LISW-SDirector of Healthcare Operations

1033 N. High StreetColumbus, OH 43201

office: (614) [email protected]

AIDS Resource Center Ohio

Page 19: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

EHR at GO CARE

Richard Womack, MSW, LCSWExecutive DirectorGO CARE

Page 20: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Founded in 1987, GO CARE provides prevention education and direct services to stop the spread of HIV disease and to assist those infected and affected by HIV/AIDS

Greater Ouachita Coalition Providing AIDS Resources and Education, Inc.

Page 21: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Geography Located in the

Northeastern Part of Louisiana

Serves 12 parishes.

Largest geographic public health planning area of the state

Has some of the poorest areas in the country.

Page 22: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

HIV Testing and Counseling Non-Medical Case Management Transportation Housing Outpatient Medical Care Mental Health/Substance Abuse Nutritional Counseling

Funded by Ryan White Part B and C

Page 23: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Up until 1/1/15, GO CARE subcontracted outpatient medical care to a local state supported hospital.

With the termination of that contract, GO CARE made the decision to embark on establishing its own outpatient clinic.

Our first clinic was held 6/1/15. Current caseload:• 115 patients receiving medical care• 225 clients receiving other services such as

nonmedical case management.

New Clinic

Page 24: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

So You Thinking About an EMR?Well Do I Have the Perfect One For You!

Page 25: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Think before you ask! Are you looking for a EMR or a Patient

Management System or both? What platforms will you be using? How many providers will have access? What are your IT capabilities? What is your budget?Because when you ask…you will be bombarded with calls and offers! And all will promise you that their system is the best!

Page 26: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Suggestions Talk with other providers, not with salesmen Get a sense from your medical providers if

they have used or seen other EMRs that they would recommend

Talk about operating systems with your IT staff and if you don’t have an IT staff, find one you trust.

Know what you need before…EHR/PM and reporting requirements including HRSA for Part C entities.

Page 27: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

What we got….AdvancedMD

PROS Fairly easy to use Runs on multi

platforms Web based PM optional Allows for Electronic

population of lab E-prescribes

CONS Templates for office

visits not necessarily applicable to HIV care

Training was web based and by phone

PM costs more Does not generate

HRSA reports, so duplicate entry into CAREWARE.

Page 28: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

EHR at ARCW

Mandy Kastner, MPHDirector of Quality AssuranceAIDS Resource Center of Wisconsin

Page 29: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Statewide medical, dental, and mental health, pharmacy and social services

10 offices Over 3,500 people with HIV served Over 2000 health care patients NCQA Level III Patient-Centered

Medical Home

HIV Medical Home

Page 30: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Service RecordMedical Epic

Behavioral Health & AODA Epic

Dental Scheduling, billing and ePrescribing in Epic; Clinical documentation in Dentrix

Clinical Pharmacy Epic

Retail Pharmacy QS-1; Access to Epic

Social Services Service plans and progress logs in Provide Enterprise; Care coordination activities and

billing in Epic

Records at ARCW

Page 31: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Largest market share in the country ARCW uses Ambulatory Care record Care Everywhere – Health

Information Exchange Module MyChart – Electronic patient portal Practice Management – Resolute

(Billing) and Cadence (Scheduling) Meaningful Use Certified EHR

About Epic

Page 32: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

ARCW uses EPIC as our EHR supported through the Oregon Community Health Information Network (OCHIN), rather than through another healthcare facility

About OCHIN:• One of the nation’s largest and most successful

health information networks• Nationally recognized for its innovative use of Health

IT to improve the integration and delivery of health care services

• Emphasis on safety net clinics (FQHCs) and small practices as well as critical access and rural hospitals.

OCHIN Epic

Page 33: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Collaborative membership model Offers other professional services and

knowledge• Workflows• Interfaces• Reporting

18 States Over 4500 physicians 3,000,000 patient visits annually

OCHIN’s Reach

Page 34: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

ARCW relationship with OCHIN Contract with OCHIN for Epic, housed

on their servers in Oregon Participation in multiple workgroups Account Manager Assigned Epic Analyst Reporting Subscription Service

Page 35: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Pricing for OCHIN Epic Startup costs – build out/customize software to the

workflows of the organization. Startup costs – interfaces – build whichever is

needed (examples:  Dentrix, Lab) Monthly licenses – EMR and PM (Practice

Management/Billing) visit Per visit charge – EMR and PM visit Hardware/software fee – per EMR and PM visit Reporting license – must have one scheduler and

one designer per organization visit count – fee to purchase, then a monthly maintenance fee

Reporting Subscription Service

Page 36: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Able to bill all service lines – whether or not the service was recorded in Epic’s EHR.

System flexibility in setting defaults Payer set up is flexible enough to set up specific

payers for a specialized function Billing review and edit structure allows for proactive

error correction System is very controlled or closed Electronic remittance posting User-friendly layout and functionality Only Downside: Write offs need to be done on an

individual basis vs. a batch write off

Billing through OCHIN

Page 37: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Hundreds of pre-written reports ARCW employees hold licenses to run reports from

EPIC through Crystal Reports Reporting Subscription Service Acuere QOL Population Manager (not through OCHIN) ARCW has full time data analyst

NOT RSR Ready• Utilize Crystal Reports to write reports to extract data,

manually import into RSR Ready software (Provide Enterprise)

EHR Reporting Capabilities

Page 38: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Summary of Epic through OCHIN

Benefits OCHIN Epic Collaborative

geared toward safety net clinics

Shared record among Medical, Behavioral Health; Interface with Dental

Interfaces with nearly all major medical centers (in WI)

Billing is efficient – bill for all service lines through Epic• Average 35 days in AR

Robust Reporting Capabilities User-friendly workflows

Disadvantages Not an RSR-ready EHR Collaborative decision

making Requires dedicated

time for participation in collaborative

Cost Clunky Population

Management capabilities

Page 39: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

PopulationManager® allows each medical care team to: Track the populations and measures based on

several common chronic conditions (HIV, hypertension, diabetes, depression, hyperlipidemia)

Identify gaps in care View the team's progress by quality measure

and compare to other care teams Gives a snapshot of each individual provider’s

performance on quality indicators

Population Manager

Page 40: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Population Manager

Page 41: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

Type your questions into the Q&A box on the right hand side of your screen.

Send the questions to the “Webinar Host” and don’t forget to click submit!

Questions?

Page 42: Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director,

You will find slides from today’s webinar on our website: www.nationalhivcenter.org

Webinars are available on our website for on-demand viewing.

Please complete the evaluation at the end of the webinar. Join us for our next two webinars:

The Affordable Care Act: Building Health Equity for LGBT People

Monday, December 7, 2015 @ 2:00 PM ET

National HIV/AIDS Strategy 2020 and Federal Action Plan: Implications for ASOs, CBOs, and Health Centers

Monday, December 14, 2015 @ 1:00 PM ET

Thank you!