Medical Communication Systems, Inc.www.medcomsys.com

EHR Implementation

mMD.net EHR Implementation: An Overview

1. Implementation Kick-off

2. Discovery

3. Technology Assessment & Acquisition

4. Initial Setup & Configuration (Workflow / Structure / Content)

5. Interfaces: Build / Test / Go-Live

6. Migrating/Loading Patient Demographics and Clinical Data (as feasible)

7. Quality Assurance: Technology / Configuration / Interfaces / Migration

8. Training

9. Go- Live

10. Review: Quarterly / Annually

Kick-off

Reviews:

Quarterly/

Annually

Go-LiveTrainingQA

Data Migration/

Loading historical

data

Discovery

Software

Configuration

Tech

Assessment &

Acquisition

mMD.net EHR Implementation: An Overview

Interfaces:

Build/Test/

Go-Live

Step # 1: Implementation Kick-off

� Formation of the Steering Committee for efficient and effective management of the Project

� Designating Single Point Contacts on both sides and documenting their responsibilities

� Establishing communication protocols, project tracking and review frequencies, and knowledge transfer methods to MCS

� Agreeing on the documentation of the knowledge to be transferred by the physician’s office to MCS and vice versa

� Agreeing on deliverables and establishing acceptance criteria of agreed upon deliverables; and project schedule

� Identifying Key Performance Indicators and their measurement

� Formalizing terms and conditions for managing Software Enhancement Requests

Step # 2: Discovery

� Practice/Organization details

� Details for all users and groups who will be using EHR including Front Desk, PA, Nurse, MA, Physicians or any ancillary staff

� Details for all Servers, Desktop, Tablet/Laptop, Printer, Scanner at the practice

� All networking and remote connection details for the server and other computers.

� Most commonly used Medications, Diagnosis, Handouts, CPT’s, Labs, etc

� Any reports or correspondence that needs to be generated using EHR.

� Details for clinical complaints, Review of Systems, Physical Examination, etc

� Any templates that the practice would like to incorporate

� Any other clinical or non-clinical documentation that needs to be addressed by the EHR

Step # 3: Technology Assessment & Acquisition

� Reasonable approach: utilize existing investment

� Reasonable approach: optimize overall throughput and performance

� Overall throughput depends on appropriate selection of technology

� Due consideration to innovations, stability of platforms, scalability, robustness, and comparing TCO while selecting appropriate technology

� mMD.net EHR Server is designed for Microsoft Windows Server OS 2008 / Microsoft .net Framework 3.5 / Microsoft SQL Server 2008

� Utilizing touch screen based tablets maximize the ease of use and superior design of mMD.net EHR

� Working with existing IT vendors is encouraged yet helping find other alternatives is also recommended

� Ensuring deliveries to satisfy the project plan

Step # 4: Software Configuration

� Reasonable approach: Start with specialty specific defaults

� Reasonable approach: Incorporate “improvisations” over defaults

� Clinical Templates and Order Sets form crux of the “Clinical Best Practices”

� Clinical Alerts and Disease Management

� Due consideration to the Health Information Exchange

� Preferences for managing workflow: the real tool for enhancing efficiencies

� Frequent interaction with coordinators / physicians / clinicians

Step # 5: Interfaces (Build/Test-Go-Live)

� Setting up mMD.net Interoperability Adapters for integrating:

� Patient Demographics

� Scheduling

� Billing

� Reference/Hospital Labs & Tests

� SureScripts/RxHUB

� Medical Equipments, such as, Vitals, Spirometry, Holter, EKG etc.

� Coordinate with third-party vendors and practice for testing each interface

� Upon completion of testing, take interfaces “Live”

Step # 6: Migrating/Loading Demographics and Clinical Data

� Identification of all external system data stores that are required to support the deployment of mMD.net database (e.g. patient demographics)

� Conversion of data from the existing databases to the mMD.net database, involving further steps such as:

� identifying existing databases and segments of databases that will be moved to tables in the mMD.net database

� designing procedures for converting the data identified from the existing databases to the mMD.net database

� developing software for accomplishing each conversion

� testing the conversion using test data

� testing the conversion using live data

� verifying the conversion results

� Getting old records in EHR: Scanning / Populating Clinical Lists

� Deployment of mMD.net database with data migrated from legacy systems, old records, and definition of Masters

Step # 7: QA: Technology/Configuration/Interfaces/Migration

� Certifying that technology acquisition and deployment is as planned and expected for mMD.net implementation requirements

� Ensuring that the information provided by the physician’s office is configured accurately and as expected

� Process check demands approval from the physician’s office that the configuration has been done to their satisfaction

� Taking a “dry run” of the complete application is not unusual as part of the QA process which also verifies and validates data migration

� A Post Configuration Report (PCR) is filled-in that includes details of the complete technology deployment, software configuration – default plus customizations/personalization, and accuracy and validity of data – migrated and Masters.

� PCR is eventually handed over to the Tech Support Team

Step # 8: Training

� Focus on training physicians office as a group as well as individuals

� Structured training program to maximize class room (presentation) based training and hands-on training

� Approx. 20 hours of online training per FTE provider before scheduling onsite training

� Training schedule is published in advance to ensure that the physicians office can make appropriate resources available

� All application modules are covered, including the Administrative module

� Partners shadow-over to learn from the training programs conducted by MCS in addition to structured train-the-trainer manuals and Certification Program

Step # 9 /10: Go-Live / Reviews: Quarterly/Annually

� Focusing on upfront online training, followed by onsite training ensures implementation going live

� Continued guidance and assistance through online sessions and phone consultations is provided, especially during initial months after going-live

� KPI identified at Kick-Off are reviewed quarterly during the first year and thereafter annually. Typical KPI reviewed are:

� Improvement in E&M Coding

� Reduction in Transcription Costs

� Increase in Workflow efficiencies measured by reduction in pharmacy call-backs, increased compliance to pharmacy benefits, increased adherence to confirmed appointment scheduling (or reduction in no-shows), increased call-back follow-up to appointment cancellation, reduction in wait-time at each stage of patient visits

� Increased compliance to clinical alerts

� Increased revenues through timely charge capture

� Increased revenues accrued through eligibility verification

� Reduction in scanning lab reports

� Increased revenues through P4P bonuses and demonstrated & measurable quality improvements

Once the go-live has been completed, the Core Team revisits users/locations/providers to assess how progress has been made. This allows for any changes to be made quickly & keeps the client on track to reach their goal. This step is critical for change management.

Assess

Go-live strategy will vary depending on which phase is being implemented. (See roll-out diagram) Providers are brought live in small groups utilizing ancillary staff as support.

Go-live

The final step before go-live is critical. The scope of training will be designed to maximize time by considering training space, number of users to be trained, and skill level. Competency testing will be administered.

Train

The test step, includes testing of any enhancements, interfaces, or templates. This phase also allows for any changes to be made prior to end-user go-live.Test

This step is where the specifications that have been defined and designed are executed.Build

Once the specifications have been defined, the design work begins. Sample templates would be created as part of this step. Workflow diagrams are created to utilize during end-user training. MCS will complete interface design in conjunctionwith the other vendor.

Design

From this starting point, the MCS team works with the client’s Core Team to create a definition of what needs to be accomplished in order to reach go-live for the given phase. This can include items such as specifications for interfaces, review of the KBM for template enhancements or changes, or identifying pertinent information for chart abstraction. This step also serves to identify any changes in workflow that may be occurring and how they will be managed via MCS.

Define

An Iterative Approach

An Iterative Schedule

Typical Tentative Roll-Out Plan (Solo thru Three Providers)

Project Step \ Week 1 2 3 4 5 6 7 8 9 ==>

1.Project Kick-off (Week-1)

2.Discovery (Week 1 & 2)

3.Technology Assessment & Acquisition (Week 3/4/5/6)

4.Software Configuration (Week-3/4/5/6)

5. Interfaces (Week-3/4/5/6)

6.Data Migration (Week 3/4/5/6)

7.QA – Technology+Configuration+Interfaces+Migration (Week-6)

8.Training (Week 7 & 8)

9.Go-Live

10.Review (Quarterly / Annually)