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EMR Implementation Managing Scope Creep Sustainability? Mark Chustz, PhD CEO Greene County Hospital
EMR Implementation
Managing Scope Creep
Sustainability?
Mark Chustz, PhD
CEO Greene County Hospital
Time Lines
2014 Last year to Initiate Medicare EMR
2015 Medicare Penalties Begin
2016 Last year for Medicare Incentive Pay
2021 Last year for Medicaid Incentive Pay
Major Expense Components
Software Vendor
◦ Initial Purchase Pricing
◦ Ongoing Monthly Support
In-house PC and Server Support
Facility Infrastructure Install & Support
◦ CAT 5 lines to every PC, Scanner, Printer
and Equipment Interface
Managing Scope Creep
Scope Creep can be defined as
uncontrolled changes or continuous
growth in project goals and objectives
resulting in cost overruns
Causes of Scope Creep
Customer’s lack of knowledge as to:
◦ Software required to accomplish Meaningful
Use
◦ Hardware required
◦ Infrastructure upgrades required
Vendor inclusion of software modules
unrelated to achieving Meaningful Use
Poor change control oversight
Weak project manager
◦ Poor communication between parties
Request for Proposal Process
Request Copies of RFPs from:
◦ Other Hospitals
◦ Vendors
Educate Governance and Physicians
regarding Cost/Benefit of attaining
Meaningful Use
Specify Attainment of Meaningful Use
◦ Specify Timelines for Implementation
Request for Proposal Process
RFP response should separate out
essential software modules from those
that don’t contribute to achieving MU
Ideally, the cost of computers, servers,
printers and scanners expense delineated
in response
Return on Investment/Sustainability
Investment cost includes:
◦ Initial purchase price
◦ Annual support
◦ Hardware purchases
◦ Infrastructure upgrades
Return on Investment/Sustainability
Software modules ROI
◦ Most modules have no + ROI
◦ ER & Clinic modules can significantly
improving coding
◦ Medication management systems ensure
proper E&M code level assignment
◦ Materials management improves inventory
control
Return on Investment/Sustainability
◦ System-wide scheduling can improve efficiency
of diagnostics patient flows
◦ Automated appointment reminders sent out
improves compliance with follow-up and
annual checkups: increasing number of annual
visits by same patient
Negotiate the Price
Set a date for vendor selection
Vendors get serious about negotiating price
when they have a deadline
Pricing can move substantially in last days before
decision
Vendor may be willing to assist with financing
purchase
Tie some portion of vendor payment to
attainment of Meaningful Use, if possible
Important Implementation Ideas
Assign one person to lead clinical
implementation process, ideally a nurse.
◦ Computer literate
◦ Optimistic
◦ Workaholic
◦ Self starter
◦ Authoritative, but with great leadership skills
Important Implementation Ideas
Communicate importance of attaining Meaningful Use goals system wide
Create financial incentives for both leaders and followers involved in the process
Keep your eye off the prize
◦ Weekly updates necessary
◦ Do Not hand off this project
Find a physician champion when possible
◦ May not be your youngest MD, might be MD most concerned about hospital’s survival
Important Implementation Ideas
Stay Flexible
Don’t expect vendor to stay on top of
meeting all MU objectives
Celebrate success where and when you
find them, don’t wait until it’s all done
It’s never all done
Contact Info
Mark Chustz, PhD
CEO Greene County Hospital
Office 205-372-0200
