Stage 1 Process Improvement of In-processing Customers · Stage 1 Process Improvement of In-processing Customers . ... this document is used as a way to propose a technology solution

Troy Delanoe Anderson IFSM 305 – Case Study: Stage 1 November 5, 2014

Stage 1 Process Improvement of In-processing Customers

The in-processing of customers as described in the Case Study documentation shows an extremely inefficient method currently emplace at the UMUC Family Clinic. Most of the inefficiency comes from waste of time and duplication of information resulting in wastes of time. Throughout this document, we will look at why this process is inefficient and the use of a technology may speed up the process for all parties involved. As described in the Case Study, Figure 1 demonstrates the basic workflow mapping in a diagram form. As-is, the process requires the patient to wait (one of the chief complaints of patients) on a nurse to start the process of checking the patient in. Because of the staff availability, the nurse may not be at her station (looking for patient records or handling other miscellaneous tasks) or may be on the phone with another patient, office or third-party representative. This initial inefficiency is very poor to demonstrate to customers of any business at the initial beginning of any service. Instead (as demonstrated in Figure 2), a patient would be able to almost immediately (if not immediately) sit down at a kiosk or terminal and start their in-processing. For new customers, they will have to create a login (with their basic information attached). Returning customers can just enter their login details to start the in-processing. Currently, if patients are not scheduled (a walk-in) their medical record must be built or located during the check-in process. This is another exorbitant waste of time. Building a record can be tedious; although it will be required with any technology used, it’s much easier to let a patient fill in the necessary information in steps which populate an EHR, than have the nurse put a hard copy together. Also, the time wasted searching through files to locate a walk-in returning-patient record is time wasted that she might be doing other things like helping customers or processing patient billing data. The to-be for this process automates the creation of a new patient. The patient will be able to go through easy to understand steps and fill out their information, which creates an EHR in the UMUC Family Clinic system. If they are a walk-in or not, the system can not only schedule the walk-in but completely check in the patient if they are scheduled. Finally, there is the issue of patient’s yearly validation of their information (another chief compliant). The current process requires the staff to hand off the same paperwork that the patient initially filled out. The patient fills it out and the nurse validates if anything has changed. The to-be for this is much easier. It takes much less time looking at information and checking to see if anything changed, than writing everything in from scratch. There is unlikely much demographic data that will need changed, but the current process requires all this to be filled out again. Duplication of data is not an efficient process in any business process. As can be seen in the figures provided, most of the workload for these processes are transferred from human to machine to complete. Although the actual workflow mapping may not show much difference in amount of tasks per diagram, the time saved and removal of duplicated data is great. No matter what technology choice is picked, having a process like this in place is exponentially more efficient than the current process in place.


Figure 1 - Patient In-processing Process AS-IS


Figure 2 - Patient In-processing Process TO-BE

Running head: PROCESS TO BE IMPROVED: IN-PROCESSING PATIENTS 1

Process to Be Improved: In-processing Patients

Troy D. Anderson

University of Maryland University College

Author Note

This is an assignment for the UMUC class IFSM 305 Information Systems in Health Care Orgs.

PROCESS TO BE IMPROVED: IN-PROCESSING PATIENTS 2

Abstract

After initial analysis of the UMUC Family Clinic Medical Practice case-study and modelling a

process AS IS and TO BE, this document is used as a way to propose a technology solution for

the designated case-study. A brief explanation of the business process identified in Stage 1 and

how/why it could benefit from the EHR system is discussed, along with information on the

proposed specific certified EHR system. All major hardware, software and communication

components are listed along with the requirements for implementation. Installation of equipment

and cost are also briefly discussed as well as why the choice of SaaS/not-SaaS was made.

Finally, a full explanation of how the proposed solution will improve the process, QOC, safety

and financial management decisions of the UMUC family clinic is described.

Keywords: Electronic Health Records, Electronic Medical Records, Healthcare

Information Technology, Kareo, Medicare and Medicaid Incentive Programs


Process to Be Improved: In-processing Patients

According to the UMUC Family Clinic Medical Practice case study, there has been a great deal of patient complaints in regards to the in-processing procedure. Because of this immediate feedback from customers, it is easy to find solutions to the problem. The bulk of this paper will focus on an HIT solution with EMR/EHR abilities and how it can directly improve this process.

Improvement to Current Process Customers are currently complaining of the procedures currently in place to in-process

patients. Not only are some of the steps redundant, but cause excessive work for both customers and staff. The major issues are with: nurses being preoccupied with other duties which requires patients to have extended wait times, nurses must waste time searching for medical records (which could also constitute as a HIPAA violation if lost), and the waste of time and duplication of data associated with the patient’s annual review of their information. All of these can be easily handled with an HIT solution by using an in-processing kiosk and EHR. Having the kiosk and EHR system will allow patients to immediately in-process at arrival, health record information will easily be at the disposal of the nurse and doctor through a simple search tool, and patients can review their data annually by viewing and only updating information necessary for change with the kiosk.

Chosen HIT Solution

• Product: Kareo EHR • Version: 3.0 • Additional Software Required: Healthwise, Updox, popHealth • Certifying Body: Drummond Group Inc. • CHPL Product Number: 03142014-2096-6

Proposed Hardware Software Requirements Kareo, as an EHR solution, must be used on specific hardware in order for it to operate

correctly. There are many ways in which it may be implemented, but its minimum requirements for use on a PC are (Kareo Practice Management System Requirements, 2014):

• 2 GHz Intel Pentium 4, Pentium D, or Core processor • Microsoft Windows XP with Service Pack 2 installed • Video card capable of 1024 x 768 screen resolution • 17” Monitor or larger • 1 GB RAM or greater • Broadband Internet connection with speed of 768 Kbps or greater • Access to a printer

These are the minimum requirements. A PC with these specs or better can be purchased for $400 with monitor. Of course minimal computer specs should not be used in a professional environment. Using dual displays and more optimal computers, each station (for three offices and the front) would be around $700. On top of this, it would be suggested three very simple terminals for patients to use as the kiosks cost around $300 a piece. Total cost: $3000 for hardware.


On top of this, the location would need high speed internet which ranges from $15-100 dependent on location and what services are available in that location. Due to the monopoly Comcast has in the Adelphi region of Maryland, most likely the Blast (for $39.99 per month) or Extreme 105 (for $89.99) would be chosen. Both offer more than acceptable data transfer rates to ensure fast connection speeds with the Kareo server.

Final Costs for First Year

Item Cost Needed/Months Total Nurse/Doctor Terminals $700.00 4 $2100.00 Patient Kiosk Terminals $300.00 3 $900.00 Printer/Fax/Scanner $500.00 1 $500.00 Kareo EHR/PM Suite $299.00 12 $3588.00 Comcast Blast Internet Service $39.99 12 $479.88

Final Cost: $7567.88

Why Kareo as the Solution? The choice of picking Kareo as the software solution is simple. It is one of the only EMR solutions that has the option of being free and its initial cost of implementation is low enough that the practice will not be out of pocket during the first year. “Concurrent with the release of rules for the CMS Medicare and Medicaid EHR Incentive Programs, ONC also releases federal rules on the standards and certification criteria required for the ‘certified EHR technology’ that must be used for providers to qualify for such incentives” (Gugerty & McCormick, 2013). As “Kareo EHR is 2014 Edition certified by the Drummond Group for both Stage 1 and Stage 2” (Meaningful Use Resource Center, 2014), it qualifies for both the Medicaid $21,250.00 in 2014 or the Medicare $11,760 in 2014 first payment received incentives (Medicare and Medicaid EHR Incentive Program Basics, 2014).

This allows Dr. Martin to implement the software, try it and use it for up to a year without having any payment out of pocket. If he has such an issue in the future with paying for the service, even with the future incentives, he can downgrade to the free version that just has EMR abilities. This also gives him the initial capital to purchase the hardware needed to furnish his hospital for the software to run on. Kareo is not technically SaaS (Software as a Service), as it does require for the application to be installed directly to the clinics computers. It is more of Data-warehousing as a service with the renting of dataspace and software licensing. The patient portal can be seen as a SaaS, although it is an add-on component of the Kareo package. Some other parts of the Kareo software suite is Cloud based, so it is more of a hybridized SaaS and database driven software than either one or the other. Overall, Kareo is a good choice for a small practice such as the UMUC Family Clinic. “These solutions are helping more than 25,000 providers succeed” (Why Kareo, 2014). Looking at the problems associated with just the in-processing of patients, Kareo can help in the following ways: Preoccupied Nurse Causes Patients to Wait Currently there is no way for patients to in-process if the nurse at the front counter is busy with on-the-phone job duties or is accomplishing some other task. Kareo will simplify this process by


allowing the nurse to streamline her processes, not having to search for patient health records, and allowing patients to in-process without waiting for the nurse. Nurse Waists Time Searching for Medical Records Following with the above problem, nurses have record management tasks that can be extremely difficult to complete in a fast-paced environment. Lost or missing patient records could not only be a waste of time, but a HIPAA violation as well. Having Kareo EMR in place would stop this from being an issue. All data is used in a certifiably safe system and uses third-party encryption data communications protocol for transmission of data via Internet connectivity. Yearly Patient Data Review is a Waste of Time The current process being utilized requires an annual check of patient demographic and insurance data. The way this is accomplished is: patients must fill out all the same paperwork they have already accomplished and the nurse checks to see if there are any changes to the information. If there is, then the pages are swapped out and the old ones discarded. This is a perfect example of duplicate work. With the use of a kiosk, patients would be prompted during their in-processing login that they need to review their data. They could then go through pages loaded with editable fields and change any data if need be. They could scroll through the information and click save at any time. This would stop the need to physically re-write information and stop nurses from having to double check all patient information yearly.


References

Gugerty, B. & McCormick, K. (2013). Healthcare information technology exam guide for

CompTIA healthcare IT technician and HIT pro certifications. [Books24x7 version]

Available

from http://common.books24x7.com.ezproxy.umuc.edu/toc.aspx?bookid=50545.

Kareo Practice Management System Requirements. (2014, November 20). Retrieved from:

http://www.kareo.com/help/practice-management/howto/system-requirements

Meaningful Use Resource Center. (2014, November 20). Retrieved from:

http://www.kareo.com/meaningful-use

Medicare and Medicaid EHR Incentive Program Basics. (2014, November 17). Retrieved From:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/

Basics.html

Why Kareo. (2014, November 18). Retrieved from: http://www.kareo.com/why-kareo

Running head: UMUC CLINIC EHR INCENTIVE PROGRAM 1

UMUC Clinic EHR Incentive Program

Troy D. Anderson


Author Note


UMUC CLINIC EHR INCENTIVE PROGRAM 2

Abstract

Kareo EMR services were chosen as the technology to be implemented at the UMUC Clinic

during the Stage 2 assignment. This text describes why the Medicaid EHR incentive program

would be best for the UMUC Clinic to pursue for funding aid. After a brief explanation of why it

was chosen, tables are used to display the incentive program’s amounts, display the 15 core

objectives and 5 menu set objectives of the Stage 1 Measures that will be used to validate

meaningful use, and show 6 Clinical Quality Measures that will be reported.


Information Technology, Kareo, Medicare and Medicaid Incentive Programs


UMUC Clinic EHR Incentive Program

There are two current programs available to many medical professionals as incentives to adopt EHR/EMR technologies. The government Medicare and state-run Medicaid incentive programs each have different stipulations and incentive amounts. This document will outline the best choice of action for the UMUC Clinic as per information currently available to all parties involved.

Choice of Medicaid Incentive Program Maryland as a state voluntarily participates as a state offering the Medicaid Incentive

Program to eligible professionals. In September of 2014 Medicaid.gov (2014) showed an increase of 33.47% of Medicaid enrolment within the last year bringing the total number of people with Medicaid benefits to 1.14 million in Maryland. This is mainly due because “on May 5, 2013, Gov. Martin O'Malley (D) signed into law HB 228 to fully implement the Affordable Care Act” (Where the states stand on Medicaid expansion, 2014) which allowed for low-income adults to be eligible for Medicaid.

While the current swell of individuals claiming Medicaid benefits may go down in a few years, the overall number of recipients will stay at a continuous high. Already the UMUC Clinic has surpassed the “30% Medicaid patient volume” (Eligible Professional (EP) Attestation, 2014) as required by Maryland to qualify for the incentive program. The overall benefit amount for the Medicaid program if started in 2014 would be $63,750 compared to $44,000 with Medicare (Gugerty & McCormick, 2013). Considering the way in which the UMUC Clinic plans to expand, it would be best to go for the Medicaid incentive program and use the excess amount for improving infrastructure, paying for additional training and possibly leasing a secondary location as is currently projected.

In the following sections, breakdowns of information that is pertinent to this decision of the Medicaid incentive program are listed.

Tables

Table 1: Incentive Program and Amounts Payment Amounts Maryland Medicaid Payments Payment Amount will be in 2014

$21,250

Payment Amount will be in 2015

$ 8,500


$ 8,500


$ 8,500


$ 8,500


$ 8,500

Total Payment Amount will be $ 63,750


Table 2* Count Stage 1 Core

Objective Measure Explanation of how the

objective will be met at the UMUC Family Clinic using the

selected EHR 1 Record and chart

vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years, including BMI

For more than 50% of all unique patients age 2 and over seen, height, weight, and blood pressure are recorded as structured data

Since the clinic is a family medical practice, this is information that is already being captured in the workflow and will be entered in the EHR during the visit. At reporting, the EHR system will automatically extract the percentage satisfying this measure.

2 Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines

More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital or CAH have at least one medication entered using CPOE

CPOE is used for medication orders in the Kareo system and will handle most prescription orders. Only in very specific circumstances will hard copy prescriptions be created.

3 Implement drug-drug and drug-allergy interaction checks

The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period

The Kareo EHR system checks for any drug-allergy and drug-drug interaction automatically. The physician will reconcile with the system and review any allergy or drug interactions prior to prescription.

4 EP Only: Generate and transmit permissible prescriptions electronically (eRx)

More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology

Kareo has an ePrescribing system that will handle almost all prescriptions. Very few will be handed out via paper format. Records of both eRx and paper format will be calculated on a weekly basis.

5 Record demographics: preferred language, gender, race, ethnicity, date of birth, and date and preliminary cause of death in the event of

More than 80% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have at least

All demographic information is collected during initial in-processing of patients and validated with patient on a yearly basis. Kareo has ensured that these fields are available in the system to be utilized as to qualify for this Core Set Objective.


mortality in the eligible hospital or CAH

one entry or an indication that no problems are known for the patient recorded as structured data

6 Maintain up-to-date problem list of current and active diagnoses

More than 80% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have at least one entry or an indication that no problems are known for the patient recorded as structured data

Problem list and current/active diagnosis are held within the system. Kareo auto-populates for “Healthy” individuals, so no patient record is without properly structured data. All diagnosis and active treatment is immediately updated during visit.

7 Maintain active medication list

More than 80% of all unique patents seen by the EP or admitted to the eligible hospital or CAH have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

During initial visit patients are required to specify currently used medications both prescribed, over-the-counter and holistic. This is immediately entered into the system. If any medications are made at the clinic they are either ePrescribed, or entered in as being used.

8 Maintain active medication allergy list

More than 80% of all unique patents seen by the EP or admitted to the eligible hospital or CAH have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

As stated above, the Kareo system already keeps track of patient allergy information. If medication causes an allergic reaction it will be immediately documented and recorded in the system.

9 Record smoking status for patients 13 years old or older

More than 50% of all unique patients 13 years or older seen by the EP or admitted to the eligible hospital or CAH have

All patients 13 or older will be required to fill in their tobacco use at every visit. During initial in-processing, historical tobacco use is attained.


smoking status recorded as structured data

10 Implement one clinical decision support rule and The ability to track compliance with the rule

Implement one clinical decision support rule

Clinical decision support rules will be setup during initial implementation. All support rules will be documented for attesting meaningful use.

11 Report clinical quality measures to CMS or the States

For 2011, provide aggregate numerator, denominator, and exclusions through attestation; For 2012, electronically submit clinical quality measures

All clinical quality measures will be reported directly to the state of Maryland. This will be used as support of attesting meaningful use.

12 Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request

More than 50% of all unique patients of the EP, eligible hospital or CAH who request an electronic copy of their health information are provided it within 3 business days

Full electronic media copies of health information will be furnished after signature of a waiver. Partial health information will be made available to any patient who signs a separate waiver to be able to view their information from the Patient Portal.

13 EPs Only: Provide clinical summaries for each office visit

Clinical summaries provided to patients for more than 50% of all office visits within 3 business days

Clinical summaries will normally be completed on a daily basis by close-of-business. All deferred summaries will be completed at a maximum of COB the next business day.

14 Capability to exchange key clinical information (ex: problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically

Performed at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information

Kareo along with third-party proprietary software allow the exchange of information with other entities through HIEs.

15 Protect electronic Conduct or review a security risk analysis

Between the security measures that come standard with the Kareo


Table 3* Count Stage

1 Menu Objective Measure Explanation of how the objective

will be met at the UMUC Family Clinic using the selected EHR

1 Implement drug formulary checks.

The Clinic has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period

All that needs to be done is to ask the EHR vendor to enable this functionality and to have access to at least one internal or external formulary for the entire EHR reporting period. Then at reporting attest to “Yes”

2 Incorporate clinical lab-test results into certified EHR technology as structured data

More than 40% of all clinical lab test results ordered by the EP, or an authorized provider of the eligible hospital or CAH, for patients admitted during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data

All partnered labs will be able to transmit data back and forth with the UMUC Clinic. All hard copy lab results will either be manually entered or scanned into the system as attached documents to the patient’s EHR.

health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities

per 45 CFR 164.308(a)(1) and implement updates as necessary and correct identified security deficiencies as part of the EP’s, eligible hospital’s or CAH’s risk management process

system and policy/procedures setup in-house at the UMUC clinic, health information will maintain fully protected. Using encrypted drives, three-point authentication, proxy-card with cypher-locked doors, and more, the UMUC Clinic will be as secure as possible.


3 Eps Only: Send reminders to patients per patient preference for preventive/follow-up care

More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period

Patients will receive reminders via email if opted in, or by telephone/mail if otherwise inclined. Patients who receive emails will have to have the waiver signed for opt-in and have a Patient Portal login.

4 EPs Only: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP

More than 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information

Procedures and Protocol is already in-place for hard-copy information in this timeline. The P/P will be altered to also reflect the electronic access of patient health information as well.

5 Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice

Performed at least one test of the certified EHR technology’s capacity to submit electronic data to immunization registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically)

Immunization data will be available through HIE and other methods for registry and IIS. Patients can also actively ask for their immunization information to be sent to school bodies, government/military agencies or other locations with a form.


Table 4*

Count CMS eMeasure ID

CQM Measure Title

Domain Explanation of how the objective will be met at the UMUC Family Clinic using the selected EHR

1 CMS117v1

Childhood Immunization Status

Population/Public Health

Using the EHR system to record the vaccines will capture the needed information. A report will be generated from the EHR at the end of the reporting period.

2 CMS155v1 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents


Any patients aged 3-17 who either had BMI recorded, had counseling on nutrition or counseling on physical activity will be documented in the system. A report will be generated from the EHR at the end of the reporting period.

3 CMS153v1 Chlamydia Screening for Women


All women 16-24 reporting as sexually active who undergo or report undergoing Chlamydia screening will be entered into the system. A report will be generated from the EHR at the end of the reporting period.

4 CMS147v1 Preventive Care and Screening: Influenza Immunization


All patients who receive immunization of Influenza directly from the provider or patients who report receiving the immunization from an outside location will be noted in the system. A report will be generated from the EHR at the end of the reporting period.

5 CMS82v1 Maternal depression screening


Women returning to the clinic after childbirth will be screened for postpartum depression during all subsequent visits up to two years after childbirth. A report will be generated from the EHR at the end of the reporting period.

6 CMS22v1 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented


All patients will receive blood pressure checks during every visit. Any high blood pressure or follow-up visits, medications or treatments for high blood pressure will be documented. A report will be generated from the EHR at the end of the reporting period.

*Denotes that many of the attributes and functions of the Kareo system come from utilizing information available on the Kareo website (Kareo EHR Fact Sheet, 2014) (Kareo Help Center, 2014) (Meaningful Use: A Small Practice Guide, 2014) (Meaningful Use Resource Center, 2014).


References

Eligible Professional (EP) Attestation. (2014, November 26). Retrieved from:

https://mmcp.dhmh.maryland.gov/ehr/SitePages/Eligible%20Professional%20%28EP%2

9%20Attestation.aspx


CompTIA healthcare IT technician and HIT pro certifications. Available


Kareo EHR Fact Sheet. (2014, November 25). Retrieved from:

http://www.kareo.com/documents/Kareo_EHR_Fact_Sheet.pdf

Kareo Help Center. (2014, November 24). Retrieved from: http://www.kareo.com/help

Maryland | Medicaid.gov:. (2014, November 26). Retrieved from:

http://www.medicaid.gov/medicaid-chip-program-information/by-state/maryland.html

Meaningful Use: A Small Practice Guide. (2014, November 25). Retrieved from:

http://www.kareo.com/resources/whitepaper/meaningful-use

Meaningful Use Resource Center. (2014, November 20). Retrieved from:

http://www.kareo.com/meaningful-use

Medicare and Medicaid EHR Incentive Program Basics. (2014, November 17). Retrieved From:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/

Basics.html

Where the states stand on Medicaid expansion. (2014, November 25). Retrieved from:

http://www.advisory.com/daily-briefing/resources/primers/medicaidmap

Running head: KAERO IMPLIMENTATION CONSIDERATIONS FOR UMUC CLINIC 1

Kareo Implementation Considerations for the UMUC Family Clinic

Troy D. Anderson


Author Note


KAERO IMPLIMENTATION CONSIDERATIONS FOR UMUC CLINIC 2

Abstract

Kareo EMR services were chosen as the technology to be implemented at the UMUC Clinic

during the Stage 2 assignment. This text briefly explains the Kareo system’s major hardware,

software and communication components and what the expectations are for the UMUC Clinic’s

use of the system. Following this is a table of considerations which includes: IT operational and

architectural safeguards, IT project management considerations, ethical, regulatory reporting

considerations and additional considerations. Upon review of this document, the owner of the

UMUC Clinic should have all information needed to disperse funds, purchase technology and

implement the system.


Information Technology, Kareo, HIT technological considerations, ethical considerations of HIT


Kareo Implementation Considerations for the UMUC Family Clinic

There are many considerations that should be taken into effect prior, during and after implementation of the Kareo system at the UMUC Family Clinic. Kareo is meant to aid in the efficiency of the clinic, relieve the burden of chaotic work for nurses and provide safer, more practical healthcare to patients. This document holds information on technical, operational, ethical, regulatory, policy and project management considerations for the implementation of the Kareo system.

Minimum and Recommended System Requirements

The minimum system requirements are as follows:

• 2 GHz Intel Pentium 4, Pentium D, or Core processor • Microsoft Windows XP with Service Pack 2 installed • Video card capable of 1024 x 768 screen resolution • 17” Monitor or larger • 1 GB RAM or greater • Broadband Internet connection with speed of 768 Kbps or greater • Access to a printer

While the “recommended” system requirements are as such: • 1.8 GHz Intel Core2, i5, or i7 processor • Microsoft Windows 7 Professional • Video card capable of 1280 x 1024 screen resolution or greater • 19” Monitor or larger, dual monitors • 2 GB RAM or greater • Broadband Internet connection with speed of 1.5 Mbps down, 768 Kbps up or greater • TWAIN-compliant scanner

Tables Table of Considerations*

Area High/Medium/Low Importance or Relevance or Not Applicable (N/A)

Explanation for Ranking /How you will address it

(minimum 2 sentences for each, linked to specific EHR technology solution proposed)

I. IT - Operational Safeguards

1. Identity Management & Authorization

MEDIUM Identity management and authorization should be handled as per the tech data for the system, following what Kareo states are the best methods. This consideration falls into the medium importance category, as it is still extremely important, but by following the directions it can be done rather easily.


2. Training Programs

LOW Kareo’s website states to “plan on 2-5 hours of training for each individual in your office depending on the individual’s role and prior experience” (Kareo Implementation Guide, 2013), which is relatively a short duration. Because of this the system has helped “more than 25,000 medical providers more efficiently manage the business and clinical sides of their practice” (Kareo Recognized as One of the Fastest-Growing Private Companies in Orange County, 2014). Additional training and/or a training plan may need to be completed during or before initial implementation.

3. Continuity of Operations

HIGH The continuity of operations falls under a high level of importance as during implementation, the regular operations are disrupted. Ensuring that faculty are fully trained prior to full use will lower chances of work-stoppages and allow the continuity of operations to flow smoothly. A plan must be in place for how the transition is taken into effect prior to initial implementation.

4. Incident Procedures

HIGH Incident procedures need to be created during the initial risk assessment and is extremely important to have accomplished prior to implementation. As per Gugerty & McCormick (2013): “Covered entities and business associates are required to implement policies and procedures to address security incidents.” Having contingency plans already in-place ensures a quick and minimally damaging recovery in the event of an incident.

5. Accountability HIGH Due to the sensitive nature of the information being used by the system and the resulting fines and sanctions levied from HIPAA violations, accountability needs to be instilled in every user of the system during initial implementation. The access rules need to be followed, and accountability to individuals in the event of incident need to be upheld and acknowledged by all.

6. Risk Assessment HIGH Risk assessment plays a huge role in many of the other areas and safeguards involved in the system. It is of almost up-most importance during initial implementation that this is fully accomplished. Future risk assessments will be necessary as time progresses. Much of the information and processes required of the risk assessment can be found on the Kareo website and other third-party websites.

7. System Activity Review

MEDIUM The system activity review policy will need to be created during initial implementation. Its actual activity is not that difficult, as the Kareo system has this ability already easily functioning and training will explain exactly how to create reports of the review and export it dependent on the timeline and variables required.

II. IT - Architectural Safeguards

8. Reliability MEDIUM Although reliability may be a high worry for the initial implementation as user’s fears may make it this, it is actually rather low-medium. The system is used by over 25,000 practitioners (Kareo Recognized as One of the Fastest-Growing Private Companies in Orange County,


2014) and with this user base, it is fair to say that it is a pretty reliable service.

9. Availability MEDIUM Due to Maryland’s possible hurricanes, ice-storms, tornadoes and other inclement weather, availability of the system is medium. For most of the year, service will easily available, however, if power or telecom goes down for extended periods of time, there is nothing that can be done besides waiting for the lines to get fixed. During implementation, this information will need to be added into a contingency program and used for risk-management.

10. Maintainability LOW Kareo pushes updates like most SaaS. As long as you are paying, updates and patches will be applied during whenever the update schedule is set. For the hardware using the systems, they will operate the software for years to come without any need for updating, besides the Microsoft and third-party software updates recommended by the Kareo IT staff.

11. Scalability LOW Since Kareo hosts all data on their servers, the scalability of the EHR is minimal. The size of the database will be proportional to the size of the patient base, and Kareo will ensure that adequate space and speed are available to the UMUC Clinic.

12. Safety HIGH Safety is pervasive in all aspects of the business and system as health is the basis of the services provided. Safety of patients, their information and the financial safety of all involved is extremely important in the initial implementation of the system. Understanding how the system is designed to make healthcare safer needs to be understood by all. The risk management process will also create contingency protocol in the event where safety may be even more of a concern, than day-to-day operations.

13. Cloud Computing MEDIUM Since third-party software and protocols will be necessary to implement the Cloud-hosted service, the Cloud Computing area of concern is of high importance. While full understanding of all the technical details associated are not necessary for the owner or practitioner of the UMUC Clinic, a basic understanding will be necessary. Representatives from Kareo have developed easy guides and videos explaining most of the information. Additional information can be found in the “HELP/LEARNING” section of Kareo or by reaching a representative which is available 24 hours a day.

III. IT - Project Management Considerations

14. Project Resources (Human, Financial)

HIGH During initial implementation, funds will not be available from anywhere besides the owner as both incentive programs require a 90 day or 3-month reporting period of use of EHR/EMR prior to dispersal of incentive funds. Because of this financial resources will be needed at first (loan) and then paid off after the first incentive amount is dropped. Additionally, all members involved in the practice will need 2-5 hours training (Kareo Implementation Guide,


2013) to learn the system and time devoted to transcribing information into the system.

15. Medical Paper Record Migration

HIGH Initial implementation will require a vast amount of time transcribing records and information into the EHR. While some parts of the Kareo system has automation,

16. Change Management during Implementation

HIGH Just as the continuity of operations is of high importance, so too is change management during implementation. Both build upon one another. If change management during implementation is handled practicably and logically, than continuity of operations will be completed smoothly.

17. Change Management after Implementation

LOW Change will take time to get used to, however very little change will occur after implementation. Prior to any large patches of the software being installed, all users should understand what is going to change, why and how they might need to modify their operations to complete tasks.

IV. Legal, Ethical, and Regulatory Reporting Considerations

18. Business Associate Contracts

LOW Kareo and third-party software vendors are already knowledge and understanding of the Business Associate Contracts and healthcare standards associated with adopting EHRs. Because of this the importance is rather low, although it needs to be accomplished.

19. HIPAA HIGH Ensuring HIPAA compliance will be the other most important aspects of initial implementation. Following HIPAA regulations and protocols will ensure that all other areas of this list are handled properly. If HIPAA regulations are not followed correctly, not only could it require the payment of fines, but a loss of incentive payments, loss of medical license and even criminal charges (malpractice).

V. Additional Consideration

20. Use of Recommended Hardware Tech

MEDIUM As stated above, there is the minimum hardware and computer technology that the Kareo system can run on and a ‘recommended’ technology. While the minimum hardware may be usable now, and may cost less, it will not be good for the maintainability and reliability of the system. As patches continue to update, there is a possibility of running out of optimal resources for the applications. Having a recommended system or above will guarantee that the hardware systems do not need to be replaced for a long time and will aid in the reliability of the system.

*Denotes that many of the attributes and functions of the Kareo system come from utilizing information available on the Kareo website (Kareo EHR Fact Sheet, 2014) (Kareo Help Center, 2014) as well as the specifically quoted information.


References


CompTIA healthcare IT technician and HIT pro certifications. Available


Kareo EHR Fact Sheet. (2014, November 25). Retrieved from:

http://www.kareo.com/documents/Kareo_EHR_Fact_Sheet.pdf

Kareo Help Center. (2014, November 24). Retrieved from: http://www.kareo.com/help

Kareo Implementation Guide. (2013, September). Retrieved from:

http://www.kareo.com/documents/Kareo_EHR_Implementation_Guide.pdf

Kareo Practice Management System Requirements. (2014, November 20). Retrieved from:

http://www.kareo.com/help/practice-management/howto/system-requirements

Kareo Recognized as One of the Fastest-Growing Private Companies in Orange County. (2014,

October 1). Retrieved from: http://www.kareo.com/about/news/press-releases/2014-10-

01-kareo-recognized-as-fastest-growing-private-companies

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