Dissecting the EMR System Development Life Cycle by pcu59739

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									Dissecting the “EMR”
System Development Life
Cycle

         Belinda Pirtle
   Carr Instructional Design
 Thursday, February 21, 2008
Healthcare
“Value Added Service”
                 An electronic medical record
                   provides….

                 Cost-Effective Treatment
                 High Quality of Patient Care
                 Preventive Health care Services
                 Compliance with Industry
                    Standard

                 Performance Data
                   Patient Satisfaction
                   Clinical Outcome
“Physician Value Added Service”

                                 I fainted at the
                                 doctor’s office last
                                 week. I actually saw
 Management of Patient Data      the doctor within
                                 five minutes of my
 Improve Quality of Care         appointment time.

 Lower Cost and Manage Risk
 Adapt to Regulatory Changes
 Administrative and Management
     Benefits
Healthcare
“Value Added Service”
                 An electronic medical record
                   provides….

                 Cost-Effective Treatment
                 High Quality of Patient Care
                 Preventive Health care Services
                 Compliance with Industry
                    Standard

                 Performance Data
                   Patient Satisfaction
                   Clinical Outcome
“Physician Value Added Service”

                                 I fainted at the
                                 doctor’s office last
                                 week. I actually saw
 Management of Patient Data      the doctor within
                                 five minutes of my
 Improve Quality of Care         appointment time.

 Lower Cost and Manage Risk
 Adapt to Regulatory Changes
 Administrative and Management
     Benefits
“Technology Enhancements”

 Computerized Patient Record (CPR)
 Electronic Health Record (EHR)
 Practice Management Systems
“Electronic Medical Records”

 Hospital Electronic Medical Records
 Medical Practice
 Specialty Electronic Medical Records
Centralized EMR Model


                User Authentication

                   Patient Data




   Secure
Office Server

                                      Physician Workstations
Types of EMR
Hospital

 EMRs designed for hospitals are
 typically offered by large software
 vendors such as Cerner, IDX,
 Siemens, and Meditech.

 Always integrated with the Hospital
 Information System (HIS), the Lab
 Information System (LIS), and other
 information systems throughout the
 organization
Types of EMR
Medical Practice EMR

             EMRs designed for medical practices
             are typically offered by small to medium-
             sized companies.

             Geared toward a specific type of
             workflow or specialty within a medical
             practice.
Specialty EMR
Single Specialty
  Designed with one specialty in mind.
  Unique documentation and workflow requirements

Multi-specialty
 Designed for a wide range of specialties
 Modules that allow different specialties to use the
 screens that pertain to them.
Documentation Methods

 Dictation and Transcription
 Templates
 Scanning
 Voice Recognition
 Hand-writing Recognition
EMR Infrastructure
ASP-Based EMR

   ASP-based EMRs are also known as web-based or
   Internet-based EMRs.

   Hosted on a secure server, which may be located within
   the medical organization or offsite.

   Screens are actually HTMLpages that allow the user to
   send and receive information to the secure database.
EMR Infrastructure
Client Server-based EMR

 Client-server-based EMRs are usually on "Local Area
 Network"

 Server located within the medical institution.
Wired vs. Wireless


Wired EMRs The computer is usually stationary at the
point of care.

Wireless EMRs The computer has a receiver built
into it.

Receives signals which are transmitted from the
server.
Secure technology allows doctors to carry around a
tablet computer that feels like a clipboard.
“Method to the Madness”
System Design Life (SDLC)
Phases of System Design and Implementation

  Initiation and System Concept
  Planning
  Requirements Analysis
  Design and Development
  Integration and Testing
  Implementation
  Operation and Maintenance
  Disposition
Initiation and System Concept

 Scope of the Project
 Project Team formed
 Initiation Timeline
 Implementation Schedule
Identify Project Team
 Practice/Business
 Champion
 Practice Champion
 Project Lead
 Healthcare Business
 Analyst
 Technical Lead
 Vendor Representative
Practice/Business Champion
 Accountability of the success of the
 Project
 Providing Project Direction
 Providing Business Direction
 Coordinating Business Area Resources
 Approving Project Budgets
 Resolving Project Issues
 Appropriate Review and Approval of
 Project Deliverables
 Ensuring acceptance and integration
 between practice and patients
 Sign the checks
Clinic Champion

 Mastering the System
 Go-To Person for System
 Issues
 Creates and Maintains Issues
 Log
 Create Buy-In
 Training Lead
 Proficiency on System
Project Lead
               Reporting to the Project Sponsor or Business
               Champion
               Assuming the primary responsibility for
               comprehensive project management
               Preparing Project Plans, Schedules and
               Budgets
               Coordinating Project Resource Activity
               Managing/Monitoring Contractors
               Communication and Status Reports
               Preparing/Monitoring Change and Decision
               Requests
               Quality Assurance and Sign off of Deliverables

               Conducting Final Acceptance Testing
Healthcare
Business Analyst
 Analyze User Needs and
 Gathering User Requirements

 Responsible for Functional
 Requirements Document

 Providing Business Direction

 Major contributor to User
 Documentation and Testing
 Plans

 Participating in User and
 Acceptance testing
Technical Lead

             Understands the Practice Business/User
             Requirements
             Transforms detailed requirements into
             System Design and System Integration
             Ensuring Business/Technical (IT)
             Integration
             Coordinating End User Testing
             Major Contributor to the Deliverables of
             the Implementation Phase
Vendor Project Lead

 EMR Demonstrations
 Testing
 User Requirements
 Installation
 Training
Practice Feasibility Report

   Medical workflow processes that will be
   affected
   Medical areas/units that will be affected
   Medical data that will be collected
   Practice Management Applications that will be
   changed
Project Budget
Determine Total Costs
    Vendor Software
    Interfaces
    Third Party Software
    Conversion Services
    Implementation Services
    Training Services
    Data Recovery Services
    Annual Support & Maintenance
    Financing Alternatives
    Terms
                 Example Project Budget
             Category            Expense description   qty   unit cost   lifespan       annual cost
network performance
                                 (no special
                                 needs)                                     1       $        -
network wiring
                                 extra network
                                 drops to room         3     $    125      10       $       38
                                 Phone in room         1     $    300       1       $      300
network hardware
                                 8 port hub            1     $    500       5       $      100
network services
                                 Server-based
                                 storage (9GB
                                 drive)                1     $   1,100      5       $      220
desktop hardware
                                 Computers             3     $   2,000      4       $     1,500
shared peripherals
                                 network printer       1     $   1,300      4       $      325
Software
                                 OS and utilities      3     $    250       2       $      375
                                 stats application
                                 license               3     $    200       1       $      600
Maintenance
                                 10% of hardware
                                 value per year        1     $   1,130      1       $     1,130
technical support
                                 EMR system
                                 support (during 1
                                 year)                 1     $   3,600      1       $     3,600
EMR Software
                                 (none)                                     1       $        -
Interfaces
                                                       1     $   3,600      1       $     3,600
Third Party Software
                                 (none)                                     1       $        -
Conversion Services
                                 (none)                                     1       $        -
Implementation Services
                                 (none)                                     1       $        -
Training
                                 (none)                                     1       $        -
Data Recovery
                                 (none)                                     1       $        -
Annual Support and Maintenance
                                 (none)                                     1       $        -

Project total                                                                       $     11,788.00
Cash Flow Budget
5 Year


            Category       expense description           yr 1         yr 2           yr 3           yr 4           yr 5
    network
    performance
                          (no special needs)
    network wiring
                          extra network
                          drops to room          $           38   $        -     $        -     $       -      $       -
                          Phone in room          $          300   $      300     $      300     $     300      $     300
    network hardware
                          8 port hub             $          500   $          -   $          -   $          -   $          -
    network services
                          Server-based
                          storage (9GB
                          drive)                     $     220    $          -   $          -   $          -   $          -
    desktop hardware
                          Computers              $        1500    $          -   $          -   $          -   $    6000
    shared peripherals
                          network printer            $     325    $          -   $          -   $          -   $     325
    Software
                          OS and utilities       $        1,250   $          -   $   1,250      $          -   $   1,250
                          stats application
                          license                    $     600    $      600     $     600      $      600     $     600
    Maintenance
                          10% of hardware
                          value per year         $          150   $      150     $      150     $      150     $     150
    technical support
                          EMR system
                          support (during 1
                          year)                  $        3,600   $   3,600      $   3,600      $    3,600     $   3,600
    Contracted services
                          (none)
    Total                                            $ 8,483      $   4,650      $   5,900      $    4,650     $ 12,225
Project Initiation Timeline
                        Project Initiation Time Frame
     Timeline                 Responsible Role          Process

      Project Kickoff          Practice Business         Appoint EMR initiative
                               Champion                  committee

      2 – 3 Months             Project Team              Define Scope, EMR
                                                         Charter, Feasibility,
                                                         Budget
      1 Month                  Healthcare Business       Gather clinic and system
                               Analyst                   requirements

      1 Month                  Project Lead              Develop RFP. Send to
                                                         Vendors

      1 Month                  Project Lead              Review RFP, Product
                                                         and Site Demos, Vendor
                                                         Selection
      1 Month                  Project Lead, Practice    EMR selection, contract
                               Business Champion         negotiation, and
                                                         financing arrangements
      1 – 2 Months             Technical Lead/Vendor     Define Medical Practice
                               Project Lead              Network Requirements,
                                                         order equipment, and
                                                         network installation
      2 – 3 Months             Project Lead/Technical    Practice Management
                               Lead, Vendor Project      Integration and EMR
                               Lead                      software install
      2- 3 Months              Project Lead/Technical    Implementation “Go
                               Lead                      Live”
Requirements Analysis
 Gather End User Requirements
 Analyze All Processes
 Functionality Requirements Document
 Request For Proposal
Integration and Testing

 Product Demonstrations
 EMR Testing and Integration
 Contract Negotiations
 Purchase EMR
EMR Design and Development

 Physical office layout
 EMR Hardware Requirements
 Networking Multiple offices
Implementation

 Implementation Schedule for “Go Live”
 Change Management and Training
 EMR is Phased into Practice “Workflow”
Operation and Maintenance
Disposition

 Reporting for “Value Added Services”
 Service Level Agreement negotiated
 Protect Data
 HIPAA Compliancy
 EMR Monitoring and Upgrades
Putting It All Together
 Investment
 Return on Investment
 Where Do You Go From Here?
Cost Estimation

For a top-of-the-line EHR, plan on an initial investment of
$15,000 to $30,000 per physician for software, hardware,
implementation and training.

15-percent to 18-percent annual software support fee, which
covers upgrades and service.


Annual costs of $5,000 to $15,000 over the first five years.
Return on Investment

 Reduced transcription costs
 Savings in paper-chart-
 related costs
 Improved staff efficiency
 Improved coding, charge-
 entry, and accuracy
 Charge capture
 Improved Provider
 Productivity.
Systems Implementation Consultant

 Excellent Planning skills
 Experience with MIS project management
 and vendor/product selection
 Experience in the health care industry
 Knowledge of Medical Records and EMR
 status and issues
      Belinda Pirtle
Carr Instructional Design
Bpirtle@Carr-Design.net
WWW.Carr-Design.Net

								
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