Practice Fusion
Strategic Planning Document:
A Plan for Conversion, Integration, and Implementation of Electronic Health Records (EHR) in a Residential Care Facility
Description of Institute
The objective of this study is to examine the implementation of a new information technology data-management plan at a residential care facility for individuals with mental illness/mental retardation. This facility also provides day treatment and respite care. This will include a two-person practice for a Nurse Practitioner and a Psychiatrist. The institute at focus in this study is a residential care facility for individuals with mental illness and mental retardation.
The mission of the residential care facility is to provide day treatment and respite care in addition to care for mentally ill and mentally retarded individuals in the best possible setting with the most effective treatment available.
Business Model
The term ‘assisted living” is defined by the Assisted Living Facilities Association of America as any group residential program “that is not licensed as a nursing home and that provides personal care and support services to people who need help with daily living activities as a result of physical or cognitive disability.” (Institute of Medicine [IOM], 2003) Placing residents in an environment that is more home-like has been demonstrated to “foster a greater degree of self-sufficiency among residents, lower costs, and a higher sense of self-esteem.” (Institute of Medicine [IOM], 2003) Assisted living facilities while not offering the full freedom associated with independent living are still not as restrictive as is the nursing home environment. Residential living facilities serve to bridge the gap between independent living and nursing home care. The residential care facility is designed to promote “individualized attention and opportunities to address residents’ individual needs and personal desires.” (Institute of Medicine [IOM], 2003) The business model is such that addresses the physical, emotional, and spiritual welfare of the residents. The team will make provision of assistance with medications, dressing, grooming, bathing, and dining and all other activities associated with daily living. The program will provide a level of care that ensures the best quality of life through anticipation of and exceeding the needs of residents.
IV. Governance Structure — Organizational Chart with All Stakeholders
The following figure illustrates the governance structure of the residential care facility.
Figure 1 — Governance Structure
V. Change Transformation Framework
Implementation of the EHR system will be based upon the ‘Change Transformation Framework’ shown in the illustration labeled Figure 2.
Figure 2 — Change Transformation Framework
Change Transformation
Assessment of Transformation Planning Transformation Implementation
Target Analysis Plan for Stakeholder engagement Activities to motivate stakeholders and Readiness Analysis Plans for Sponsor Engagement sponsors
Needs assessment of: Plan for Development/Implementation
Individual adoption
Education/Developmental
Institutional Adoption
Communication
Transformational Communications
Planning for Communication Implementation of Communication Adoption of Communication
Learning Development for Transformation
Education and Developmental Planning Implementation of Training Deployment of Development
As shown in the above figure transformation to EHR system use involves several phases including:
(1) Transformation assessment
(2) Transformation planning;
(3) Transformation implementation
(4) Transformation communications; and (5) Transformation learning development.
VI. Project for Implementation
Practice Fusions HER (Electronic Health Record) was developed from the real workflows of physician’s practices. The free, web-based EHR system is a fully-feature system that enables the physician and/or the facility to effectively manage the practice. The system can be utilized for appointment-scheduling, completion of a medical chart, sending of prescriptions with the e-prescribing feature and even billing for services. The EHR is reported as being easy to use enabling the physician and/or facility to sign up for the service and to immediately begin charting.
VI. Overall IT Plan and Planning Time Horizons and Organizational Budgeting
The typical implementation of the Practice Fusion EHR is approximately 1 year’s time. While the Practice Fusion EHR upfront cost is relatively low, training of employees and the addition of certain employees will represent some expenses to the organization’s budget.
VII. Sponsorship Team and Implementation Team
The objective of the plan is to facilitate the desired outcome for the residential care facility including an increase in integration and interoperability amongst multiple facilities, to make provision of multiple methods for information presentation, facilitation of identification and location of patients and to introduce the standardization of accessibility protocols, to provide support for data integrity and confidentiality and to make provision for systems operation and maintenance in the determination of system and data accuracy.
The stakeholders that are responsible for making contribution to the implementation of EHR at the residential care facility will be inclusive of customers, various levels of management, outside experts and business and IT leaders. The customers, or the EHRs end users include health care consumers and clinicians will make provision of the necessary inputs in regards to policies, procedures, requirements, and usability of the system. The management team will have the responsibility for roll-out of the system and to ensure that staff members are sufficiently bought in and able to contribute to the system implementation. The industry consultants and vendors will make provision of the needed outside perspective for the organization and will provide the necessary tools for EHR implementation.
VIII. Strategy for Capturing Current Workflow
The identified strategy for capturing the current workflow includes those stated as follows:
(1) Identification of stakeholders;
(2) Conduct a structured team interview;
(3) Observe the process;
(4) obtain copies of paper forms and tag them to a step;
(5) Get copies of the policies and procedures in place;
(6) Obtain a copy of the management and control reports;
(7) Present findings to the stakeholders.
The following illustration identifies key stakeholders, key EMR capabilities, and the systems that support and interact with EMR.
Figure 3
IT infrastructure, telephony and internet access are reported as “just some of the resources in which companies invest large amounts of money but only use by 10% to 45%. his low utilization rate of resources, coupled with the unperceived duplication of these, significantly increases operating costs (OPEX), which imposes a heavy burden on businesses.” (Panotech, 2012) Panotech protect will protect the organization’s IT system through its unique infrastructure design and development for the residential care facility that will be “cost-effective, scalable, and manageable.” (Panotech, 2012) Panotech provides IT management and maintenance services as well as disaster recovery services.
Part Two
I. Process for Request for Proposal for System Chosen and Reason for Selection
The process chosen for request for proposal for the chosen system and the reason for selection involves a comparison of the vendors who offer EHR/EMR systems. The facility is currently using an electronic patient care charting system, a physician ordering system, and a pharmacy ordering system. The following objectives are recommended:
(1) Creation of a mission statement for implementation of full EHR
(2) Project management team development and implementation.
(3) Key stakeholder involvement from each user group to inform IT.
(4) Make certain executive management and ongoing support for the project exists;
(5) Selection of vendor;
(6) Written benchmarks to measure success and in testing effectiveness.
Necessary as well is demonstrating to early adopters how success has been realized through the use of EHR. Also important is the integration of a wish list in the discussions on functionality and introduction of new product releases. Partial implementation of EHR has occurred at the residential facility and there is an expectation for resistance in the creation, adoption, and implantation of the full EHR system. It will be of key importance that current employees are surveyed concerning their feelings in regards to implementation of a full EHR system in the residential care facility. The survey has been constructed and includes the following stated questions:
In an effort to prepare the residential care facility for implementation of the electronic health care records and an interoperable system of electronic health records, the team has prepared a readiness assessment to identify questions that need to be answered as strategies are developed for appropriate implementation appropriate. The assessment tool is used for the purpose of gathering data that the implementation will use throughout the implementation process to ensure the successful roll out of the EHR.
Readiness Assessment
Question
What is the most positive aspect of the system in your opinion?
Question
How do you perceive the system will affect your work/responsibilities?
Question
What are your primary concerns about the new system in terms of your use of the system?
Question
Please state two methods that can be used to reduce your concerns about use of the system?
IV. Business Case for Implementation of the New System and Strategy for Choice of Vendor
The strategy used for the choice of vendor for the EHR system involves a comparison of vendors that provide such systems. There was an extensive list of vendors compared with the top chosen being those listed as follows which make provision of electronic health record solutions for the health care industry which have been screed for the their system’s capacity for interfacing with other systems and solutions:
(1) Vendor: Netsmart Technologies
Website Address: www.ntst.com
Solution: Avatar, Social Services Data Management
Overview: This system makes offerings of a full range of health solutions and a comprehensive practice management system. Avatar PM, case management, Avatar CWS, and industry leading EHR management solutions. Benefits of this system including the reduction of budgets and staffing and automation of clinical processes, compliance with emerging electronic health record (EHR) requirements; flexible, next-generation financial, clinical and management systems including electronic medical billing; Interest in applications to support caseworkers in mobile, disconnected settings; Desire for data analysis, reporting and benchmarking.
(2) Vendor: Defran Systems
Website Address: www.defran.com
Solution: Evolv-CS
Overview: EVOLV-CS is a completely integrated Electronic Health/Medical Record (EHR/EMR) and system. Included are case and clinical management tools that are of an advanced nature as well as reporting and billing features and supports. Included in benefits are automation of administrative tasks, revenue increases, cash flow improvement, and data entry and paperwork reduction.
Core Features of the System:
Referral Processing & Intake
Client Information & Record Management
Assessments & Treatment Planning
Service Delivery & Productivity Aids
Quality Improvement & Outcomes Management
Resource Family & Facility Management
Comprehensive & Integrated AR / AP Management
Extensive Reporting Solutions
Front Desk Scheduling and
(3) Vendor: REHAB-EMR
Website Address: www.rehab-emr.com
Solution: REHAB-EMR
Overview: This is patient-centered software that specializes in paperless charting and documentation for physical and occupational therapists in outpatient rehabilitation clinics, skilled nursing homes, sub-acute rehab centers, and hospitals. Benefits of the system include enhanced Productivity, Reduced Overhead Costs, Improved Patient Care, Clinical Documentation At Point-of-Care, Intuitive System Workflow, Automated Coding and Compliance, More Effective Management, Customizable Functionality, Lower Cost of Ownership, Enhanced Analytics
Features: An innovative therapy documentation system designed for physical and occupational therapists and their administrators, web-based system designed to use internet/intranet technology. Access to the system is through a standard Web browser and supports a wide array of hardware platforms, including wireless Tablet PC’s and Laptops, Linux, SQL-based
(4) Vendor: SourceMedical
Website Address: http://sourcemed.net/
Solution: TherapySource
Overview: TherapySource is a therapy practice management software solution, delivering comprehensive functionality and is used by the majority of all large PT chains in the U.S. TherapySource is a scalable solution for small clinics and built to streamline and automate clinical and financial processes, including EMR, scheduling, registration, clinical documentation, billing, revenue cycle management and more. TherapySource physical therapy software is ideal for clinics looking for software that can grow with them. Benefits include the system being built to handle multiple sites across the enterprise, TherapySource is the practice management solution for large chain clinics in America. Whether you own 2 or 2000 clinics, TherapySource is the most scalable, comprehensive practice management system in the industry. TherapySource has a built in EMR featuring a unique knowledge base designed by top rehab professionals in the industry. TherapySource is the best business partner for managing scheduling, registration, clinical documentation, billing, revenue cycle management… And much more.
Major Features: Reporting and Clinical Documentation; Scheduling and Clinical Documentation; Coding, Billing & Collections
(5) Vendor: Optimus EMR, Inc.
Website Address: www.optimusemr.com
Solution: Opitmus EMR, C.N.A. Kiosk or PDA Point of Care Module
Overview: The Icon-based CAN Charting Module is engineered with total software automation. Primary features include:
The Optimus C.N.A. icon-based charting module allows C.N.A.s to document or observe all of the following:
ADLS, Mood and Behaviors;
Continence (Bowel and Bladder);
Vitals,
Intake and Output,
Meals;
Care Plan Driven C.N.A. Task Lists;
Resident Messages entered by ;
Clinical Alerts generated by the OEMR Alerts; Dashboard;
esident Complaints;
Restraints;
Restorative Nursing Assistants and Restorative Therapy documentation; and Therapists minutes.
The following chart lists the various systems compared along with the system’s architecture, language, payment methodology and website address.
Figure 4 – Systems Compared
Company Name
Software Name
Architecture
Language
Payment Methodology
Website
Altos Solutions, Inc.
OncoEMR, oncology-specific EMR
Web-based or Client-hosted
Annual Subscription for MDs & Extenders, all others free http://www.altossolutions.com/
BetterHealth Global (USA), Inc.
BETTERHEALTH record
Client-Server and web based
Delphi
Monthly per Provider or One time plus annual maintenance http://www.bhgusa.com/
DoctorsPartner
DoctorsPartner
Client-Server (web based)
ASP
Monthly per Provider
http://www.emr-electronicmedicalrecords.com/
Intuitive Medical Software
UroChart EMR
SAAS and Client-Server
C#
SAAS – Monthly per Provider
Client-Server – One time with annual maintenance http://www.intuitivemedical.com/
MedbaseInc
Medbase
LAN server or web-based your choice
MS Visual Fox c++ Adobe
No monthly fees one time http://www.medbaseinc.com.com/
MDoffice
MDoffice
LAN & web based
Delphi SQL Server
licensed or subscription http://www.mdoffice.com/
Medical Voice Products, Inc.
MPS
LAN
.Net
One time plus annual maintenance http://www.medicalvoiceproducts.com/
Medicat
Medicat
Client-Server
Visual Basic
One time plus annual maintenance http://www.medicat.com / meridianEMR
meridianEMR
“Blended” SAAS and Client-Server
Java
One time plus annual maintenance http://www.meridianemr.com/
NexTech Practice
NexEMR
Client-Server
Native C++, Transact-SQL
One time plus annual maintenance and technical support http://www.nextech.com/
Patient Now
Medical Records Suite
Client-Server
C##
24 months http://www.patientnow.com/
PracticeFusion
Practice Fusion EMR
SAAS
C# .NET & Adobe Flex
Free (ad supported) or $100 per provider per month (no ads)
http://www.practicefusion.com/
Sevocity
Sevocity EHR
SAAS
Java
Monthly per Provider
Company Name
Software Name
Architecture
Language
Payment Methodology
Website
SSIMED
SSIMED EMRge
Client Server/Hosted
.Net
One time plus support http://www.ssimed.com/
STI Computer Services
ChartMaker Medical Suite
Client Server
C++ and C# .Net
One time plus annual maintenance http://www.sticomputer.com/
TECNEX Systems LLC
TECNEX POMS
Client-Server
C#
One time plus annual maintenance http://www.clinicbusinesspartner.com/
Webahn, Inc.
Capzule
Web-based / iPhone
Java
Monthly (starting at $50)
http://www.capzule.com/
WebDMEMR
WebDMEMR
Web Based
ASP.NET
Monthly per visit, user and disk space http://www.webdmemr.com/
The system chosen is that of the Practice Fusion EMR system which includes the iPad EHR, Web-based EHR, EHR Drawing, Patient Portal, e-Prescribing, Lab Integration, EHR Interoperability and Medical Charting. The reasons for this choice include the integration of the system and its ability to operate with other already in use systems and the low cost for implementation of this IT solution.
III. Timeline for Planning Process
The timeline for the planning process includes the following segments:
Development — 6 months
Implementation — 3 months
Roll-out and assessing — 3 months
V. Chart of Key Stakeholders and Pros and Cons
Types of change that are encountered in the implantation of the EHR system include the following types of changes and their accompany characteristics:
(1) Operational: changes in the methods of the ongoing operations of the conduction of business and automation in specific areas;
(2) strategic changes in the business direction;
(3) Cultural changes in the basic philosophy of the organization and the conduction of business;
(4) Political changes due to changes in staffing.
There are various personalities that emerge during organizational change that must be dealt with including the following personalities:
(1) The Initiator — this personality perceives the challenge or opportunity and conceptualizes the change that needs to be made in response to these challenges or opportunities;
(2) The Approver — this personality is a power figure in the organization that supports the change, which has been proposed;
(3) The Leader — this personality is a visible and enthusiastic supporter of change who works in rallying support for the change in who provides maintenance for that support.
(4) The Facilitator — this personality assists in making the organizational change process smooth and is generally involved from the beginning of the change.
(5) The Developer — this personality takes responsibility for the technical aspects of the organizational change.
(6) The Installer — this personality holds responsibility for change implementation including the needed training and support activities;
(7) The Doer — this personality has to perform their work in the changed environment;
(8) The Obstructionist — this person guards the status quo and is against the change;
(9) The Customer — does not view that they will be impacted immediately by the change and observes the change with interest; and (10) The Ignorer — views the change as having no personal impact and is indifferent to the change.
The following tables lists the stakeholders and members of the project.
Figure 4 — Stakeholders and Project Members
Group
Job Title
Major Project Roles & Responsibilities
Executive
CEO / President
Participate in developing Mission Statement
Support Project
Identify & Help to Resolve Obstacles to Implementation
Executive
Nurse Executive
Participate in developing Mission Statement
Support Project
Identify & Help to Resolve Obstacles to Implementation
Identify Budget & Restraints
Approve Project Plan
Certify Vendor Selection
Certify Vendor Solution
Support Go-Live
IT
Manager
Facilitate Project Plan
Serve as liaison between stakeholder groups
Participate in vendor selection
Primary contact with vendor
IT
IT Operations Manager
Perform acceptance testing
IT
Operations
Provide requirements for operations
Perform operational testing (e.g. server loads, etc.)
Departmental Groups
Project Manager
Work with IT Project Manager for departmental deliverables
Departmental Groups
Business Analyst / Informatician
Define business processes & requirements
Participate in acceptance testing
Participate in training plan development & execution
Participate in vendor selection
Departmental Groups
Advanced User / IT Leaders
Contribute business processes & requirements
Participate in training plan development & execution
Departmental Groups
Physicians
Approve project plan schedule
Participate in training plan development
Departmental Groups
Nurses
Participate in training
Part Three
I. Infrastructure Roadmap for Project and Budget
Funds for the EHR system implementation are divided between ongoing and upfront costs. The majority of the costs of implementation will be in the area of personnel costs. The implementation of the electronic health record (EHR) system makes requirement of budgeting for the following:
Upfront Purchase and Licenses & Maintenance or Subscription Fees for Web-Based Solutions
Implementation Costs including Personnel Training & Overheard including lost time for training
Implementation Costs: includes gathering of requirements and acceptance testing.
Implementation Costs: including redundant costs that ensure a working and tested process is in place with simultaneous assessment testing, raining and roll-out.
The budget must account as well for the subscription plan needs, which include the internet connection fees for the web-based solution.
Recommendations include the development of a comprehensive policy with standardized procedures that make provision of patient confidentiality and data security. The policy must incorporate the HIPAA framework and provisions for the following:
(1) Provision to patient of a list of what is known about them and who knows this information;
(2) Provision to patients of the reasons and purpose for the collection, storage and utilization of the information;
(3) Provision of assurance to patients that the data is being collected only for the reasons and purposes stated;
(4) Provision to patients of the ability to consent as to the collection, use, application and dissemination of their information as well as destruction of the information;
(5) Provision to patient of the capacity to control access to their information;
(6) Provision to patient of the ability to request copies of their information and the capacity to change, correct, modify or update their information;
(7) Provision to patient of assurances that their information is stored in a private and secure manner;
(8) Provision to patient of assurances that their information can only be viewed by those with the rights and permissions to view their information;
(9) Provision to patients of a method of auditing the accountability of the policies and procedures; and (10) Provision to patients with recovery plan should their information somehow be compromised.
The collection, storage, access, modification and reporting procedures on the personal health data of patients should be inclusive of general information security measures and permissions, including encrypted data and secure passwords.
The necessary steps to assess resistance to change in the organization are listed in the following illustration labeled Figure 5 in this study.
Figure 5 — Identification of Types of Resistance
Practice Fusion, which is a fully integrated solution will make provision of interoperability between each electronic health record system for the various residential care facility departments.
EHR system department and the integration of each will follow a simultaneous project plan and will operate under the same milestone schedule.
Proposed Project Start Date: July 1, 2012
Proposed Project End Date: July 1, 2013
Proposed Project Duration: One Year
Quality, confidentiality, and security will be feature-rich, cost-effective and to include the core competencies as follows:
(1) Application User Interface;
(2) Interoperability & Integration based on Standard Messaging
Included in the EHR system will be graphical user interfaces and web-based applications.
The EHR system implantation will include provisions for the secure storage of data ensuring that data does not become compromised or published inadvertently. Data integrity will be a provision of the system ensuring that only necessary data is collected and provided. The system provisions include data integrity ensuring that only authorized users are able to access the data and providing for proper dissemination of the data across the organization.
II. Specifics on Additional Personnel Needed for Implementation and Maintenance of System
Additional personnel needed for implementation of the system includes an IT Operations Manager and Team. The EHR Practice Fusion system is fully designed for interoperability with other systems in the health care setting.
Part Four
I. Implementation Plan Inclusive of Stages for Technical Infrastructure
Stages of the implementation plan include the discussion and communication stage followed by the planning and development stage, assessment of needs and support, training and installation, testing and monitoring followed by roll-out of the plan in July 2013.
II. Training of Personnel
Personnel will be trained by Panotech technicians on use of the system.
III. Roll-out Timing
Because of the nature of the Practice Fusion system, the system will be rolled out with assistance from Panotech technicians. Roll-out is to occur 1 July 2013.
IV. Trouble-shooting Support
The deliverables for the EHR system implementation are system requirements from management, clinical and operational staffs including the development, testing and certification of those requirements as well s the installation and ongoing maintenance of the system. The requirements will be collected and summarized through use of application development tools, information and proposals will be collected from vendors and automated through use of electronic bid management through the purchasing division. Project management tools can be used to assess the system’s implementation. Training will be provided through computer-based training tools. EHR system deliverables include the following:
(1) health record system integration;
(2) interoperability;
(3) graphical presentation via web-based applications;
(4) online reporting and querying audits in a secure and restricted environment.
The IT Management team will be responsible for developing and maintaining a security monitoring and security breach response team. The management team will be responsible for the development and maintenance of standard quality check reports in compliance with the security policies and procedures as well as being responsible for requesting that the vendor make provision of tools for testing the system making sure the right information is collected in the right locations at the right time. A quality assurance team is responsible for periodic testing of the system, which includes testing for accuracy in the system’s processes, application and output. After implementation of the EHR system there should be quality checks performed on the following schedule:
30 day check
60 day check
90 day check
These measures for accuracy should be enacted and should includes questionnaires for end users, which are used in the quantitative rate the system. A forum for suggestions and for sharing knowledge should be provided which will enable feedback. There should be logging of improvements that are suggested, errors that are unexpected and user experiences that are satisfactory.
. It is crucial to follow-up with end-users and to ensure their needs and suggestions are listened to and a resolution is provided to the end-user. This helps to ensure cooperation for future endeavors and respect for the implementation and operational teams.
V. Expected Outcomes
The following future benefits map shows the expected outcomes of the EHR system.
Figure 6 — Expected Outcomes
Current Current Improvement Future Outcomes
Pain Points Challenges Opportunity
Too much time No sense of urgency automation of manual Project implemented quicker
In maintenance for change support tasks work
Customer satisfaction is low.
There are various stages required in realization of future benefits and that includes working through the present difficulties and current obstacles as well as accessing opportunities for improvement all of which will result in the realization of future benefit of the EHR system.
Costs of Practice Fusion System Development, Implementation, and Roll-Out
The initial cost for the Practice Fusion applications costs $100.00 per month per physician. The additional support and training features are not stated on the Panotech website but can be estimated at 200.00 per month. The addition of employees will cost the organization 1600.00 per month for two IT employees to be hired.
Conclusion
This document has related the choice of the Practice Fusion electronic health record (EHR) along with the various planning and design needs as well as the process for training, communication, assessment, monitoring, service and maintenance, and the final roll-out of the system in one year’s time. The Practice Fusion EHR will serve to integrate all the processes of the residential care facility and to streamline the operations of the facility. The system can be used for charting, ordering or tests, prescribing medications, location of patients, and keeping of health records across all departments of the residential care facility. The system is relatively simple to install and use and training will be provided by Panotech, the vendor for Practice Fusion.
Bibliography
Giglio, P and Ingram, J (nd) Critical Features of an EMR System: Addressing major agency challenges through strategic functionality. Defran Systems. Retrieved from: http://www.defran.com/_pdf/whitepapercriticalfeatures.pdf
Key Capabilities of an Electronic Health Record System (2003) Consensus Report. Institute of Medicine (IOM) Retrieved from: http://www.iom.System.aspx
Price, M. et al. (2011) EMR Adoption Model. E-Health Observatory. 17 Feb 2011. Retrieved from: http://ehealth.uvic.ca/resources/tools/emradoption/2011.02.17-EMRAdoption_Model_Handbook-v3.0.pdf
What is Practice Fusion (2012) Panotech Website. Retrieved from: http://www.panotechgrp.com/en/partner/practicefusion.pcsg
