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Electronic Health Record Solutions to Provide Great Care
Mike Gifford, MBAPresident & CEO, ARCW
Anna Wuerth, MSW, LISW-SDirector of Healthcare Operations, ARC
Ohio
Richard Womack, MSW, LCSWExecutive Director, GO CARE
Mandy Kastner, MPHDirector of Quality Assurance, ARCW
Market Forces Driving EHR
Mike Gifford, MBAPresident and Chief Executive OfficerAIDS Resource Center of Wisconsin
The ‘new’ leading care delivery system
HIV patients’ needs go well beyond HIV
Many sources of data (lab, pharmacy, specialty care)
Patient contact information can change frequently
All care needs to be documented in one system & available to all providing care
Integrated Care
Greater patient choice Greater efficiency in registering and
caring for patients Automated communication with
patients Patient involvement in care greatly
expanding
Patient Experience
Focus on quantity is diminishing Focus on quality is expanding Easy access to data for process
improvement Funding tied to quality outcomes Accreditation and recognition may be
tied to EHR Quality applications for EHRs may be
within the system or an overlay
Quality Outcomes
Federal appropriations level at best Private funding challenged by new
and different priorities ACA drives changes in public funding Reimbursement funding is the future Payment tied to quality outcomes
Funding
Perspectives on EHR from AIDS Resource Center Ohio
Anna Wuerth, MSW, LISW-SDirector of Healthcare OperationsAIDS Resource Center Ohio
FY16 Annual Budget: $44 million • 6 times our post-merger budget 4 years ago
13 offices in 10 cities 220 staff
• 3 times as many staff as post-merger 4 years ago Providing medical care to roughly 1,400 patients Assisting more than 5,000 HIV-positive individuals with
services such as case management, behavioral health therapy, housing assistance, medical care and pharmacy services
Reaching more than 25,000 with community education, evidenced based prevention interventions and free HIV testing
AIDS Resource Center OhioTransformations Post 2011 Merger
Identified Organization’s Top 3 Requirements of an EHR: Implementation Speed
• ARC Ohio Board of Directors Vote to Open a Medical Center and Pharmacy: Winter 2012
• Opening Day: October 2012 (Only 8 months of planning time for ALL clinic/pharmacy opening activities!)
Cost of Service• Needed something affordable
Comprehensive Service Options • Billing, scheduling and electronic health record
Electronic Health Record Rollout In a New Clinic
CareCloud
CareCloud- Cloud Based System
Strengths Fulfilled our day-one
opening needs for necessary billing and charting activities
Provider progress note templates easily adaptable
Basic data was retrievable in excel format reports
Simple to use and learn Web-based, requiring very
little IT support prior to implementation
Weaknesses Was essentially a “paper
chart” in an electronic format
Costly to establish lab interface
No onsite go-live support Limited clinical decision
making support Task routing very limited Monthly cost increased
significantly over 2 year period
Carecloud viewed as short-term solution Clinical workflows and decision making
support inadequate ARC Ohio clinic #2 planning discussions
began after year 1 of operations—marked ideal transition timing
Partnership exploration identified beneficial options
Sought a more robust system
Decision to Change EHRs
Premier Health: Access to Epic
Robust system Extensive onsite go-live
support Clinical decision making
support Improved workflow Part of larger provider
network Improved reporting
capabilities More advanced billing capabilities Well organized chart
Epic
Premier Health not as advanced as some other Epic Vendors
Requests for changes or fixes are fulfilled slowly
Lack of report related training available to staff ARC Ohio one of first clinic settings to need
such extensive reports Premier Health had not fully implemented two-
way reminder call/text features Not willing to develop interfaces
Not All Epic Vendors Are Created Equal
Multiple systems fed into one creates thorough patient profiles
Quality/data team use data imports
Used for Ryan White related reporting
Clunky system
CAREWare
Interview a variety of vendors and explore demos in depth. Involve ALL necessary staff in selection process (finance,
data, IT, providers, etc.) Contact references and visit clinic sites to see the EHR in
action. Must understand reporting capabilities of system, vendor’s
report development process as well as the methods of data extraction.
Federally Qualified Health Centers (FQHC) have special reporting requirements and billing needs. • Must explore these considerations prior to committing to a
system and a vendor. TRY NOT TO RUSH THE SELECTION PROCESS.
Closing Considerations
Anna Wuerth, MSW, LISW-SDirector of Healthcare Operations
1033 N. High StreetColumbus, OH 43201
office: (614) [email protected]
AIDS Resource Center Ohio
EHR at GO CARE
Richard Womack, MSW, LCSWExecutive DirectorGO CARE
Founded in 1987, GO CARE provides prevention education and direct services to stop the spread of HIV disease and to assist those infected and affected by HIV/AIDS
Greater Ouachita Coalition Providing AIDS Resources and Education, Inc.
Geography Located in the
Northeastern Part of Louisiana
Serves 12 parishes.
Largest geographic public health planning area of the state
Has some of the poorest areas in the country.
HIV Testing and Counseling Non-Medical Case Management Transportation Housing Outpatient Medical Care Mental Health/Substance Abuse Nutritional Counseling
Funded by Ryan White Part B and C
Up until 1/1/15, GO CARE subcontracted outpatient medical care to a local state supported hospital.
With the termination of that contract, GO CARE made the decision to embark on establishing its own outpatient clinic.
Our first clinic was held 6/1/15. Current caseload:• 115 patients receiving medical care• 225 clients receiving other services such as
nonmedical case management.
New Clinic
So You Thinking About an EMR?Well Do I Have the Perfect One For You!
Think before you ask! Are you looking for a EMR or a Patient
Management System or both? What platforms will you be using? How many providers will have access? What are your IT capabilities? What is your budget?Because when you ask…you will be bombarded with calls and offers! And all will promise you that their system is the best!
Suggestions Talk with other providers, not with salesmen Get a sense from your medical providers if
they have used or seen other EMRs that they would recommend
Talk about operating systems with your IT staff and if you don’t have an IT staff, find one you trust.
Know what you need before…EHR/PM and reporting requirements including HRSA for Part C entities.
What we got….AdvancedMD
PROS Fairly easy to use Runs on multi
platforms Web based PM optional Allows for Electronic
population of lab E-prescribes
CONS Templates for office
visits not necessarily applicable to HIV care
Training was web based and by phone
PM costs more Does not generate
HRSA reports, so duplicate entry into CAREWARE.
EHR at ARCW
Mandy Kastner, MPHDirector of Quality AssuranceAIDS Resource Center of Wisconsin
Statewide medical, dental, and mental health, pharmacy and social services
10 offices Over 3,500 people with HIV served Over 2000 health care patients NCQA Level III Patient-Centered
Medical Home
HIV Medical Home
Service RecordMedical Epic
Behavioral Health & AODA Epic
Dental Scheduling, billing and ePrescribing in Epic; Clinical documentation in Dentrix
Clinical Pharmacy Epic
Retail Pharmacy QS-1; Access to Epic
Social Services Service plans and progress logs in Provide Enterprise; Care coordination activities and
billing in Epic
Records at ARCW
Largest market share in the country ARCW uses Ambulatory Care record Care Everywhere – Health
Information Exchange Module MyChart – Electronic patient portal Practice Management – Resolute
(Billing) and Cadence (Scheduling) Meaningful Use Certified EHR
About Epic
ARCW uses EPIC as our EHR supported through the Oregon Community Health Information Network (OCHIN), rather than through another healthcare facility
About OCHIN:• One of the nation’s largest and most successful
health information networks• Nationally recognized for its innovative use of Health
IT to improve the integration and delivery of health care services
• Emphasis on safety net clinics (FQHCs) and small practices as well as critical access and rural hospitals.
OCHIN Epic
Collaborative membership model Offers other professional services and
knowledge• Workflows• Interfaces• Reporting
18 States Over 4500 physicians 3,000,000 patient visits annually
OCHIN’s Reach
ARCW relationship with OCHIN Contract with OCHIN for Epic, housed
on their servers in Oregon Participation in multiple workgroups Account Manager Assigned Epic Analyst Reporting Subscription Service
Pricing for OCHIN Epic Startup costs – build out/customize software to the
workflows of the organization. Startup costs – interfaces – build whichever is
needed (examples: Dentrix, Lab) Monthly licenses – EMR and PM (Practice
Management/Billing) visit Per visit charge – EMR and PM visit Hardware/software fee – per EMR and PM visit Reporting license – must have one scheduler and
one designer per organization visit count – fee to purchase, then a monthly maintenance fee
Reporting Subscription Service
Able to bill all service lines – whether or not the service was recorded in Epic’s EHR.
System flexibility in setting defaults Payer set up is flexible enough to set up specific
payers for a specialized function Billing review and edit structure allows for proactive
error correction System is very controlled or closed Electronic remittance posting User-friendly layout and functionality Only Downside: Write offs need to be done on an
individual basis vs. a batch write off
Billing through OCHIN
Hundreds of pre-written reports ARCW employees hold licenses to run reports from
EPIC through Crystal Reports Reporting Subscription Service Acuere QOL Population Manager (not through OCHIN) ARCW has full time data analyst
NOT RSR Ready• Utilize Crystal Reports to write reports to extract data,
manually import into RSR Ready software (Provide Enterprise)
EHR Reporting Capabilities
Summary of Epic through OCHIN
Benefits OCHIN Epic Collaborative
geared toward safety net clinics
Shared record among Medical, Behavioral Health; Interface with Dental
Interfaces with nearly all major medical centers (in WI)
Billing is efficient – bill for all service lines through Epic• Average 35 days in AR
Robust Reporting Capabilities User-friendly workflows
Disadvantages Not an RSR-ready EHR Collaborative decision
making Requires dedicated
time for participation in collaborative
Cost Clunky Population
Management capabilities
PopulationManager® allows each medical care team to: Track the populations and measures based on
several common chronic conditions (HIV, hypertension, diabetes, depression, hyperlipidemia)
Identify gaps in care View the team's progress by quality measure
and compare to other care teams Gives a snapshot of each individual provider’s
performance on quality indicators
Population Manager
Population Manager
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The Affordable Care Act: Building Health Equity for LGBT People
Monday, December 7, 2015 @ 2:00 PM ET
National HIV/AIDS Strategy 2020 and Federal Action Plan: Implications for ASOs, CBOs, and Health Centers
Monday, December 14, 2015 @ 1:00 PM ET
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