1. law, govt and politics
2. legal issues
3. human rights

“How to Best Select an EHR
and
The new HITECH Stimulus Act – What you need to
know”
Presented by Scott Heaton
Vice President, Maxwell IT Company
© 2009 Maxwell IT Company. All Rights Reserved.
© 2008 Maxwell IT company. All Rights Reserved.
Session Goals…



Introduce you to an Electronic Health Record
Review the HITECH Stimulus Act and discuss
timing
Walk you through a proven process and
teach you how to avoid the pitfalls of others
who have gone before you.
© 2008 Maxwell IT company. All Rights Reserved.
Why do many EHR implementations
fail or are under utilized?
© 2008 Maxwell IT company. All Rights Reserved.
Why many EHR implementations fail
or are under utilized

The Practice is NOT prepared for change
(Lack of planning. Unclear vision, goals and
approach).

Lack of resources dedicated to the project
(Staff, time, money, end-user involvement, project
management and IT support)

Unrealistic expectations for what can be
accomplished and how quickly it can occur. Not
aligned with vendor incentives.
© 2008 Maxwell IT company. All Rights Reserved.
The Electronic Health Record
What is an Electronic Health
Record (EHR)?

Streamlines the practice
workflow through the
electronic storage and retrieval
of patient information.
What are the benefits to my
practice?

Increased quality of patient
care through accessibility of
information–Bridges the Gap

Improved patient experience by
increasing practice efficiency
© 2008 Maxwell IT company. All Rights Reserved.
Today’s EHR Patient Visit
Check-In/Reception
 New Patient Kiosk Check-in
© 2008 Maxwell IT company. All Rights Reserved.
Today’s EHR Patient Visit
Check-In/Reception
 New Patient Kiosk
Check-in
Examination
 Supports all documentation
habits including Voice Recognition
 Health Maintenance Alerts
 Medical device integration
 e-Prescriptions
© 2008 Maxwell IT company. All Rights Reserved.
Today’s EHR Patient Visit
Check-In/Reception
 New Patient Kiosk
Check-in
Examination
Check-Out/Billing
 Supports all documentation
 E&M Coding
habits including Voice Recognition
 Charge Passing
 Health Maintenance Alerts
 Follow-up
 Medical device integration
 E-Prescribing
© 2008 Maxwell IT company. All Rights Reserved.
How to Quantify Benefits
Increase Revenue & Reduce Expenses

Patient Access (+1-2 pt visits/day)

Billing Accuracy (Coding and Claims Submission)

Transcription / Printing


Paper Trail Reductions (missing charts, fax
“puddles,” claims re-billing)
Staffing (Chart Pulling, Referrals, Billing)
© 2008 Maxwell IT company. All Rights Reserved.
EHR Pay-4-Performance Initiatives
Medicare Program
FIRST YEAR
FILE
2011
2012
2013
2014
2015
2016
TOTAL
2011
$18,000
$12,000
$8,000
$4,000
$2,000
$0
$44,000
2012
$0
$18,000
$12,000
$8,000
$4,000
$2,000
$44,000
2013
$0
$0
$15,000
$12,000
$8,000
$4,000
$39,000
2014
$0
$0
$0
$12,000
$8,000
$4,000
$24,000
2015 or later
$0
$0
$0
$0
$0
$0
$0
›CMS payments for professional services will be reduced (1-3%) beginning in 2015 for all
providers who are not meaningful EHR users.
© 2008 Maxwell IT company. All Rights Reserved.
EHR Pay-4-Performance Initiatives
Medicaid Program
2011
2012
2013
2014
2015
TOTAL
$25,000
$10,000
$10,000
$10,000
$10,000
$65,000
CMS penalties in 2015 do not apply
Eligibility:



Non hospital-based providers that have at least 30% of the professional’s
patient volume coming from Medicaid patients
Pediatrician who has at least 20% of the patient volume coming from Medicaid
patients*
Providers predominantly in a FQHC or rural health clinic and have at least
30% of the professional’s patient volume coming from Medicaid patients
© 2008 Maxwell IT company. All Rights Reserved.
What you need to know for
HITECH Stimulus Act


Medicare and Medicaid Program Options.
Payments begin in 2011 for practices that can prove
meaningful use with a certified EHR, penalties begin in
2015 (1-3%)

Certified vendors have not been identified.
www.cchit.org



“Meaningful Use” has yet to be completely
determined but will include:
Use of e-prescribing
Demonstrate Information Exchange and Report Quality
clinical measures.
*Certification Commission for Health Information Technology (CCHIT)
© 2008 Maxwell IT company. All Rights Reserved.
A brief look at an EHR solution.
© 2009 Maxwell IT Company. All Rights Reserved.
© 2008 Maxwell IT company. All Rights Reserved.
Best Practices for Selection & Implementation
© 2009 Maxwell IT Company. All Rights Reserved.
© 2008 Maxwell IT company. All Rights Reserved.
Objectives
What’s the Best Approach for
Selecting an EHR?
What Selection Criteria
Should You Use?
© 2008 Maxwell IT company. All Rights Reserved.
EHR Formula for Success
 Know the Total Cost/Savings
 Understand Your Time Commitment
 Before You Invest
© 2008 Maxwell IT company. All Rights Reserved.
Common Approach
Talk to
Peers
“Loop Effect”
Timeline: 1-2 years
© 2008 Maxwell IT company. All Rights Reserved.
1–2
Demo’s
Common Approach Pitfalls
Vendor pricing is not competitive
 Practice time is not used efficiently
 No clear timeline to keep the process
on track
 No structured mechanism to compare
vendors and products

© 2008 Maxwell IT company. All Rights Reserved.
Recommended Approach: RFP
Benefits

Competitive Pricing from Vendors

Physician/Admin. Time is Managed
More Effectively

Clearly Defined Set of Requirements

Clear Process to Compare Vendors
© 2008 Maxwell IT company. All Rights Reserved.
Selection Process Timeline
Step 1: Practice Profile
Learn Requirements – Prepare Practice Profile
Identify Vendors (3)
Step 2: Vendor Introduction
Initial Product Demonstrations (3)
Request/Receive RFP, Pricing Proposal
Step 3: Vendor Evaluation
Review Vendor Data (RFP, References, Comparison Matrix)
Reduce Vendors to 2
Step 4: Preferred Vendor
Detailed Demonstrations (2) - Hands-on Testing
Identify Preferred Vendor
Step 5: Reference Verification
Site Visit
Step 6: Vendor Validation
Final Demonstration
Vendor Confirmation
Step 7: Final Selection
Contract Negotiations
Timeline
(weeks)
1-3
Practice
Profile
August
2-6
Vendor
Introduction
6-8
Vendor
Evaluation
September
8-10
Preferred
Vendor
10-12
12-14
Vendor
Reference
Verification Validation
October
© 2008 Maxwell IT company. All Rights Reserved.
14-15
Final
Selection
November
RFP Document: Sample Questions
 Vendor Background
 Is your company profitable? If yes, for how long? Attach a copy of
your most recent financial statement.
 Functional Requirements
 Health Maintenance Alerts, EDI Support, Reporting, Formulary,
Drug Interaction Alerts, Messaging, Secure Email, etc.
 Technical Requirements
 What are the staff responsibilities for system maintenance and
upgrades? Expect on-going IT requirements to increase.
 Implementation Plan
 Please provide a sample project plan and timeline delineating
practice and vendor responsibilities.
 Support
 What is the average response time for problems reported?
 Pricing
 Please provide comprehensive pricing proposal including hardware,
software, services, and third party products.
© 2008 Maxwell IT company. All Rights Reserved.
© 2008 Maxwell IT company. All Rights Reserved.
Objectives
What’s the Best Approach for
Selecting an EHR?
What Selection Criteria
Should You Use?
© 2008 Maxwell IT company. All Rights Reserved.
Selection Criteria: TCO
5 Year TCO = Direct Costs + Indirect Costs + Risk Factors

Direct Costs -software
licensing, annual support,
training, hardware equipment

Indirect Costs - IT support,
lost billable physician time, new
staff training, integration
costs

Risk Factors – company
stability (company goes out of
business, product is no longer
supported)
© 2008 Maxwell IT company. All Rights Reserved.
TCO Selection Criteria #1:
Company Stability
What to focus on?
 Profitability

Red Flag: Vendor does not provide
financial statements (non-disclosures)
 Organizational Structure
 Leadership
Certification Commission for Healthcare Information Technology - CCHIT.org)
© 2008 Maxwell IT company. All Rights Reserved.
TCO Selection Criteria #1:
Company Stability
Risks Factor: Is the Vendor Profitable?
 Indicator: Annual Burn Rate is Greater
than Annual Sales
Burn Rate Estimation Tool:
(staff # end of year + # staff beg, of year)
2
X $100,000
$100,000 = Avg. FTE Cost in tech company (FTE = salary X 1.25)
© 2008 Maxwell IT company. All Rights Reserved.
TCO Selection Criteria #2:
Integrated Solution
Evaluate the following integrated solutions:
 Practice Management
 Electronic Health Record
 New…Patient Portal
 There are indirect costs with non-integrated
solutions.

The EHR Vendor should provide a complete, integrated solution
(enabling the highest ROI over a five-year period)
© 2008 Maxwell IT company. All Rights Reserved.
Integration Advantages:
Single Source Solution
Dashboard
Snapshot of
Financial/Clinical
Performance Available
to Physician at
Anytime
EHR
Patient Services
Patient
Demographics,
Scheduling, Refill
Requests, Lab
Results and
Messaging sent
seamlessly.
Billing Process
Seamless:
Super-bill step
eliminated. Encounter
data goes straight to
E&M and data
scrubbing before
processed. Any
changes in PM are
automatically updated
in EHR.
Patient can make
payments, view billing,
see lab results, and
request refills,
schedule appts. online.
Data seamlessly shared
between PM and EHR
system.
© 2008 Maxwell IT company. All Rights Reserved.
Objectives
What’s the Best Approach for
Selecting an EHR?

Utilizing a Request for Proposal
(RFP)
What Selection Criteria
Should You Use?

Developing Criteria based upon
Total Cost of Ownership
(TCO):


Company Stability
Integrated Solutions
© 2008 Maxwell IT company. All Rights Reserved.
Physician Break-Out Sessions
Virtual Lab
© 2009 Maxwell IT Company. All Rights Reserved.
© 2008 Maxwell IT company. All Rights Reserved.
Maxwell IT…Endorsed by the California Medical Association
to help select and adopt EHR solutions
We provide:

EHR Budgeting and Contract Review Services

EHR Optimization and Project Management to meet
“Meaningful Use” stimulus requirements.

Hardware and Network Managed Services
www.ehrbestpractice.com
Scott Heaton (360)903-7719
© 2008 Maxwell IT company. All Rights Reserved.