Happy Valley Practice
Electronic Health Records Project
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“The Happy Valley Practice mission is to provide a lifetime of compassionate, high-
quality primary care to adults. We strive to ensure every patient’s dignity and
The Happy Valley Practice (HVP) was founded in 1977 by four clinicians who were
committed to providing a lifetime of compassionate, continuous, high-quality primary
care to adults, particularly those at the margins of the health care system. To this day,
HVP provides care for the elderly, the chronically ill, the urban poor, and the mentally
and physically disabled. The goal of HVP is to ensure dignity and support independence.
A hallmark of HVP’s practice is to provide health care to each of their patients through
the use of nurse practitioner and physician teams throughout the continuum of care, i.e.,
in the clinic office, hospital, home, and nursing home or supportive housing settings. The
Happy Valley Practice firmly believes that the level of access to caregivers and the
continuity of care embedded in our model provides better care and achieves better health
status and outcomes than more traditional approaches. HVP carries out its mission
through the provision of care, research, teaching and patient advocacy.
Today, HVP is comprised of approximately 22 FTE providers: 11 doctors, 15 nurse
practitioners and physician assistants, and 17 administrative staff. Most clinicians
practice in multiple settings across the full continuum of care, and therefore each has a
smaller patient panel, as well as a higher number of visits per patient, than most other
group practices. All physician staff have appointments at a local medical school, and the
group has a long standing relationship with a large academic medical center in town. In
FY’04, the practice received 4,996 patient office visits and 30,278 visits across all its care
HVP intends for an EHR/PMS implementation to support the following goals:
Providing consistent, high quality care to our diverse patient mix, including the
frail elderly and chronically ill.
Provision of care at all the locations at which we provide primary care: office,
nursing homes, and at our patients’ homes.
Improving the reliability and efficiency of practice operations and communication
among clinicians and staff.
Becoming nationally recognized as a model for primary care to disadvantaged and
chronically ill patients, based on measurable outcomes and replicable processes.
Building a financially sustainable practice.
The project vision is to invest in people, business process improvements, technology
infrastructure and an electronic health record (EHR). This investment is expected to provide
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operational stability and to support growth and relevant operational objectives for next 7 to 10
years. A special emphasis is put on the improved measurement and delivery of quality
The Happy Valley Practice (HVP) is now engaged in a procurement process for an integrated
electronic health record (EHR) and practice management system (PMS). The new system will
assist us to move to a paperless office environment that will help us keep better track of our
patient information, improve our reimbursement, and streamline our office processes. We have
also identified a need to develop the internal IS/IT resources required to manage and operate the
The goals set for this project are to have a signed contract for an EHR/PMS on a tightly
controlled time line, and to have begun the process of building the internal capacity to
successfully implement, manage, and operate the system into the future within the next 5-7
months. The full implementation will take us anywhere from 12-18 months. To accomplish
these goals, the project will require:
Commitment from project stakeholders including organizational management, clinic
management, project team, and technology staff
The availability of resources (including significant staff time) to assure the completion of
high quality deliverables by the consultants
A project management structure to handle the day to day communications and logistics
Rapid response and decision-making by stakeholders, executives, managers, and other
project participants within their defined scopes of authority
GOALS AND OBJECTIVES
Several high-level goals and objectives were identified during a ‘Goal and Vision’ meeting on
February 7 at HVP. These can also be considered guiding principles as the team moves though
the system selection and implementation process.
The EHR will increase HVP’s ability to track preventative services. During the operation
redesign phase, new policies and functions will be developed to ensure that patients stay
up to date with procedures, appointments, and tests.
The EHR and resulting systems will also facilitate the measurement of chronic care
management. Initially the DOQ-IT measures will be used to show quality.
Timely, safe review and routing of lab and other results. The system will maximize the
use of outside data.
One of the primary drivers for system implementation in increased operational efficiency.
Focuses for the initial implementation will be determined by the head of each functional
area as they go through the process of evaluating their department.
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The system needs to provide interconnectivity with community practitioners to be able to
document and care for patients who are serviced at these outside sites. Community
practice providers will have ready, real-time access to patient records and
communications. New workflows will also be developed to improve and ensure good
communication with the community practice.
The EHR needs to have available or easily developed interfaces to frequently used
laboratories, including a major academic medical center. Other interfaces may include
nursing homes and other frequently used labs.
Health information management systems will aim to increase the availability of clinical
Culture and Transitions
The EHR needs to provide staff with a tool to enhance operational efficiencies, enabling
staff to provide better and faster service to patients.
The EHR must be "user friendly" to facilitate effective training and operations in a fast
Proper training will take a high priority in implementation. This includes training for the
EHR/PMS, but also any other skills needed to fit the new workflows or practice.
Providers will be encouraged to document care at the point of service, and the office and
systems will be designed to facilitate this.
The new systems will continue to support HVP’s group practice of medicine.
Providers will be given time to learn the system.
Communication about the project will be timely, regular, and comprehensive. Everyone
at HVP will be ‘in the loop’, and will know who to ask if they have questions about their
role in the organization. They will be also be comfortable contributing to the project.
EMR Budget Summary
Software (EMR & PMS) $200,000
Hardware $ 77,000
First Year's Svc/Maint $ 16,900
Implementation & $ 20,000
Allocated Clinical Time $ 19,619
Lost Revenue $134,572
Contingency 5% $ 23,405
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Executive Steering Committee:
Vendor Selection Committee:
The DOQ-IT team from MassPRO will provide consulting services through the selection,
contracting, implementation, evaluation, and improvement phases of this project.
Project Stakeholders are individuals or entities that are either directly involved in a project, who
may be impacted by a project or who can influence a project. In order to avoid issues such as
incomplete requirements and implementation problems, the project team must pay close attention
to stakeholder project awareness and buy in. The project stakeholders are:
Happy Valley Practice patients
Happy Valley Practice staff
Community practices and nursing homes
Happy Valley Practice board of directors
Major academic medical center
The following is an overview of the project plan. The full project plan is maintained by Project
Managers, and provides a detailed analysis of the milestones, dates, and resources.
- Complete HVP EMR needs assessment
- Develop Project Charter
- Develop preliminary budget
- Communication meetings with Broad of Directors, stakeholders, providers and staff
- Select EMR software programs to be considered
- Vendor demonstrations
- Design multiple work flow to capture present office and community work using visio
- Conduct site visits
- Assess hardware, office configuration options based on needs assessment
- Submit RFI to chosen software vendors
- Conduct reference checks
- Vendor selection
- Contract negotiations
- Design new work flows for office and community
- Sign software contract
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- Select hardware vendor and sign contract
- Develop chart abstraction strategy
- Develop preliminary implementation strategy
- Obtain firm vendor deliverables and dates
- Develop pre-training plan
- Update implementation strategy
- Update chart abstraction strategy
- Major update for practice and stakeholders
- Develop Go-live plan
- Install hardware
- Install software PMS
- PMS training 8/14/06
- PMS go live 8/21/06
- Install software EMR
- Install network and peripherals
- Test and implement interfaces
- Convert data from old system to new system
- 10/16/06 Training
- go live EMR 10/23/06
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