Networking Your Way to an
Interoperable EHR
Minnesota Rural Health Conference
June 28, 2010
Anne Schloegel
Minnesota Department of Health
Office of Rural Health and Primary Care
Health Information Exchange and
Interoperability
Definition of health information exchange:
Mobilization of health information electronically
across organizations within a region or community
according to nationally recognized standards
Interoperability is comprised of:
technical: transmitting of data accurately and securely
from one point to another
semantic: sender and receiver understand what the data means
process: ―best practices‖ between the sender and receiver
Why Interoperable EHRs?
• To improve health care quality, increase patient
safety, reduce health care costs and improve
public health
• Part of Minnesota’s 2015 EHR mandate
• To be ―meaningful users‖ must exchange health
information
Minnesota Model for Adopting
Interoperable Electronic Health Records

Breaks achieving interoperable EHRs into
manageable steps

Applies across organizational settings
Continuum
of EHR
Adoption
Achievement of
2015 Mandate
Adopt
Assess
Plan
Utilize
Select
Implement
Exchange
Effective Use
Readiness
Interoperate
4
Meaningful Use
 Minnesota health care providers and hospitals
could access $450-$800 million in incentives if
they can successfully demonstrate ―meaningful
use‖ of an EHR system. The three core elements
for demonstrating meaningful use are:
– Use of nationally certified EHR systems
– Submission of clinical quality measures
– Electronic exchange of health information
5
Health Information Exchange and
Meaningful Use
Health Information Exchange Transactions
Required for Meaningful Use
–Electronic Prescribing
–Immunization Information Exchange
–Laboratory Results Reporting
–Exchange of Clinical Summaries
–Public Health Surveillance and Case Reporting
Health Information Technology
Resources and Tools
• Office of Rural Health
and Primary Care
– Webpage for
HIT/Telehealth
– Monthly Update
– Quarterly
Health Information Technology
Resources and Tools
 Minnesota e-Health Web Page
www.health.state.mn.us/e-health
 Minnesota e-Health Weekly Update
―Gov Delivery‖ email distribution list
 Monthly HITECH Update Calls
– Third Thursday of the month from 4:00-4:45 p.m.
Related Sessions at the Conference
Session 3B—Navigating Medicare and
Medicaid HIT Incentives
Session 4B—Finding EHR/HIT
Opportunities and Support
Session 5A—Health Information Exchange
Opportunities
On Their WaySession Speakers
• Mark Roisen
Executive Director, Lac qui Parle Health Network
2007 Planning and 2009 Implementation Grants
• Jackie Moen
Executive Director, Northern Minnesota Network
2008 Implementation Grant
Lac qui Parle Health
Network




Non-Profit tax-exempt
hospital services cooperative
Appleton Area Health Services
Appleton
Figure 1
Johnson Memorial Health Services Dawson
Madison Lutheran Home
Madison
EHR Due Diligence

Governance Structure
> AAHS, JMHS, MLH Board
of Directors
> LqPHN Board of Directors
> LqPHN IT Steering
Committee
- Clinical
- Administrative
- IT
EHR Due Diligence
Vision

>Affordability:
>Compatibility:
>Interoperability:
>Data stewardship:
EHR Due Diligence
Strategic Plan



Functionality
Business Case
Other Factors
EHR Due Diligence:
Functionality
3 dimensional Chess Match
End Users
EHR Software
Third Party
Vendors & Payers
Existing Software &
Systems
Communication Infrastructure
Production Servers / Backup
Systems & Maintenance Plan
EHR Due Diligence:
Functionality




Steering Committee
RFP
Goal Setting
Process Mapping
EHR Due Diligence:
Business Case
>Total Cost of Ownership
>Benefits
EHR Due Diligence:
Business Case
5 year Total Cost of Ownership
Vendor A
$5,259,319.00
Vendor B (current vendor)
$4,588,669.00
EHR Due Diligence:
Business Case

Benefits
>Improved Patient Outcomes
>Cost Savings
>Productivity Improvements
>Cost Avoidance
>Revenue Increases
>Contribution to Profit
EHR Due Diligence:
Other Factors
Cost of Conversion from Current Vendor Applications to different vendor
6-12 Month Conversion timeframe during which you need to license both
systems.
Historically Accounts Receivable go up and cash flow goes down during this
transition time frame
Staff training increases significantly due to learning new systems
EHR Due Diligence:
Other Factors
Both Vendors are considered Premier Vendors for our Market
Both are Hospital based Health Information Systems with modules for clinic
and long term care settings
Both Vendors are CCHIT Certified
Both hospitals have good references
Consultants all agree either system will work well, if our staff is willing and
capable of making the transition from a paper to electronic environment
EHR Due Diligence:
System Maintenance




LqPHN received 2 grants totaling over $1.6 million
specifically for the planning and implementation of
EMR software and hardware
The LqPHN will be applying for several additional
Grants:
MDH State E-Health Grant/Loan Program
Blandin Broadband Connections
HRSA Outreach Grant
Microsoft HealthCare Grant
Group Purchasing bring down cost of ownership
LqPHN User Group meetings will facilitate adoption
of best practices in achieving meaningful use
Networking Your Way:
Interoperable EHR
NORTHERN MINNESOTA NETWORK
Jackie Moen – M.A.
Project Director
OUTLINE
1. NMN - who we are
2. Our path to health information technology
3. Our HIT system
4. Lessons learned
5. Future plans
NMN - Who We are…
 501(c)3 HCCN organization
 Health Center Controlled Network
 Started 2001 – incorporated 2004
 Mission:
provide health information technology systems,
resources and support to our Members to assist
in delivering quality patient care
NMN – Our Members
 Currently three members - FQHCs
 Sawtooth Mt. Clinic, Scenic Rivers Health
Services, Migrant Health Services, Inc.
 Operate 20 medical and dental sites in
Minnesota and eastern North Dakota
 Patients served: 25,866
 Encounters: 104,756
NMN – Our Collaborators
 Medical : 17 physicians, 8 mid-levels,
19 others – lab, imaging, therapeutic.
 Oral Health: 4 dentists, 4 hygienists, 8 support
 Exchange information with Cook Hospital,
BigforkValley Hospital, Cook County North
Shore Hospital
NMN – Our HIT Path….
 2004: Incorporated, secured funding, selection
team and project plans
 2005: Due diligence, RFP = eight responses, four
demos, two site visits, contract negotiations….
 GE Healthcare Centricity Practice Solution
 CySolutions Applications
 SISU Medical Systems
What A Crew !
Site Visits
NMN – Our HIT Path….
 2006: Developed infrastructure, phased
implementation of Practice Management
 2007: EHR Planning - readiness
assessments, process mapping, workflows,
connectivity issues, interface planning
 2007: Converted Practice Management 2004
to Centricity Practice Solution 2006 (only PM)
NMN – Our HIT Path….
 2008: EHR – ―flip the switch!‖
SMC - ―live‖ in April
 MHSI - ―live‖ in June
 SRHS - ―live‖ in September
 2008: Eleven clinical sites ―live‖, three lab
interfaces, and many tired, battle-weary folks!
 2009: Brought up nine additional sites, one
lab interface, and went from this…..

Relative calm…..
Eye of the Storm…..
CURRENT STATUS
 2010: Dental health record implementation,
imaging, HL7 interface Dentrix to Centricity
 Additional interfaces
 Optimize functionality
 QI – Data Reporting
 Expand infrastructure
Our HIT System
 Electronic Health Record
 Practice Management System
 Dental Health Record
 Voice Recognition
 E-faxing
 HIE Bridge
 Expanded Reporting Applications
 Interface Applications – Meditech, Quest
Our HIT System
 HIE Bridge

Query patient demographics between hospitals
and health center databases, participating
patients
 Expanded Reporting Applications




Crystal Reports
CCC (Chronic Disease Management)
MQIC
MN Community Measures Program
Our HIT System
 Interface Applications
 Quest Diagnostics Lab

OE and results
 Meditech Hospital Information System



Lab results only
Documents Management (ITS) - surgical
procedures, discharge summaries, rehab, ER,
H & P, OT, PT.
Transcribed report immediately goes electronically
through the interface to patient record
LESSONS LEARNED
 Use a team approach
 Must have physician champions
 Dedicated clinical and IT support
 Plan change management strategies
 Address negativity right away
LESSONS LEARNED
 Be sensitive to your workplace culture
 Set a standard people agree to live with
 Pay attention to observation terms during set up
 Process maps help avoid ―paving the cow path‖
 Provide LOTS of training, multiple formats
LESSONS LEARNED
 Double estimates for interface development
 Determine financial impact – initial productivity
costs and ongoing costs
 Be flexible – this is a LONG process
 Celebrate the early wins!
What Next?
Plans for the Network!
Projects and Plans
 Complete major upgrade v8.0 to v9.0
 Implement Sure Scripts e-prescribing
application
 Develop additional interface applications
 Expand data collections – reporting
applications
Projects and Plans
 Increase NMN membership
 Implement systems with new members
 Expand health information exchange
applications
Northern Minnesota Network
Looking for more information?
Contact
Jackie Moen
Project Director
763-444-8283
[email protected]