Assessing the Cost of VistAEHR Building a business case with ROI

Assessing the Cost of VistA/EHR Building a business case with ROI Claudine D. Beron, PMP July 3, 2007 VistA Project Life Cycle Project Management for VistA is accomplished through the use of the core areas including: initiating, planning, executing, controlling, and closing and represents over 44 processes from PMI. Initiate Educate     Plan Assess Environment Needs Standard Operating Procedures Benefits Resources Strain Budget  Execute/Control Deploy    Hardware Software Configure to Environment  Close Support Ongoing maintenance Updates/Patches Additional modules Accept Identify Stakeholders Train  Compare EHRs  Build Business  Case Develop ROI Understand Functionality   Identify Owners   Future Budgeting Complexity    Ongoing  maintenance Clinical Staff   1/16/2009 page 2 VistA – Assessing the Needs of a Hospital Executive Sponsor Customer Program Management Office Organizational Sponsors Clinical Subject Matter Experts Phase I Phase II Phase III Phase IV Initiate Plan Execute Monitor/Control Close Define High Level Clinical Requirements Define High Level IT Requirements Design Solution Build IT Solution Manage Project Plan Provide Reports Develop Change Management Develop BPR Strategy Configure VistA Solution Validate Train Staff Document Lessons Learned PMI Methodology VistA 02 Figure 002. EMR/HER Project Approach and Use of PMI Methodology 1/16/2009 page 3 VistA – Assessing Timelines/Resources 1/16/2009 page 4 What is Business Case Analysis? • • • Definition: a forecast of the financial impact, over time, of a decision – typically an investment, capital purchase, or project A full Business Case analysis forecasts the project costs, benefits, and the timing of both elements Results may be expressed as a time series (see graphic) or summarized by a single financial metric + Cash Flow Impact - Time Mark Leavitt, MD, PhD, FHIMSS. Case for EHR in Small Physician Offices - Physician Office QIOSC National Call -- January 11, 2005 1/16/2009 page 5 Financial Metrics • Net Cash Flow NPV How much extra cash will this cost or generate for our business each month / quarter / year? – Well-suited to the medical practice, where ‗cash (flow) is king‘ – • Discounted Cash Flow – + Net Cash Flow - Time Payback Period Like Net Cash Flow, but adjusted for ‗time value‘ of money Sums up the discounted cash flows to give a single value • • Net Present Value – – Payback Period How long until project ‗pays for itself‘ – Good measure of relative risk: long payback = high risk • Internal Rate of Return (IRR) Compares investment with an interest-bearing note – Not well suited to measure an IT project – buying a bond vs. implementing an EHR couldn‘t be more different! – Mark Leavitt, MD, PhD, FHIMSS. Case for EHR in Small Physician Offices - Physician Office QIOSC National Call -- January 11, 2005 1/16/2009 page 6 Business Case Analysis for EHR A. Input Office Specific Information (Rates and Averages) Number of Patients Per Day 1500 e.g. Long Term Facility Work Days Per Year 365 Average Hourly Rate of Admin Staff $55.00 Average Length of Patient Visits per Physician 15.00 Average Reimbursement Rate per Visit $250.00 Lumetra. EHR - Estimated Cost Savings Worksheet with additional inputs from Claudine Beron on implementation of VistA at 7 site facility 1/16/2009 page 7 Business Case Analysis for EHR B. Benefits Based on EHR Use (Provides a cumulative Monthly/Yearly cost savings amount) Areas Affected by Before EHR EHR Implementation Units Per Unit $ Per Per Day Costs Year After EHR Implementation Units Per Day Per Unit Costs $ Per Year Cost Savings Annual Savings Savings / Month Materials Benefits New Patient Charts Medical History Sheets Faxed Information Printer Paper Mailings Super bills Coding - Charge Capture 20 100 60 1000 500 5 100 $10 $73,000 $2 $73,000 $5 $109,500 $0 $54,750 $0 $67,525 $200 $365,000 $10 $365,000 20 100 10 500 0 0 100 $10.00 $0.10 $5.00 $0.15 $0.37 $200.00 $0.10 $73,000 $3,650 $18,250 $27,375 $0 $0 $3,650 $0 ($69,350) $0.00 ($832,200.00) ($91,250) ($1,095,000.00) ($27,375) ($67,525) ($328,500.00) ($810,300.00) ($365,000) ($4,380,000.00) ($361,350) ($4,336,200.00) Estimated Savings 1/16/2009 ($981,850) ($11,782,200.00) page 8 Lumetra. EHR - Estimated Cost Savings Worksheet with additional inputs from Claudine Beron on implementation of VistA at 7 site facility Business Case Analysis for EHR C. Staff Benefits Based on EHR Use (Provides Time and Cost savings amount) Areas Affected by Before EHR After EHR Implementation EHR Implementation Time Benefits Units Per Unit Minutes Units Per Per Unit Minutes Per Day Mins / Mth Day Mins Per Mth Chart Pulls 100 7.50 821,250. 00 90.00 985,500. 00 0.00 0.00 39 7.50 Cost Savings Savings / Month (500,962.50) Annual Savings 320,287.50 (6,011,550.00) Chart Filing/Transfers Prescribing Refills, Callbacks & Errors Dictation Time 30 50 100 0 0 90.00 3.00 0.00 0.00 (985,500.00) 0.00 (11,826,000.00) 0.00 Transcription 5.00 182,500. 80 5.00 146,000.00 (36,500.00) (438,000.00) 00 Notes Avg Cost Costs Notes Per Avg Cost Costs Per Savings / MonthAnnual Savings Per Day Per Line Per Day Per Line Month Month 40 0.15 43,800.0 20 0.15 21,900.00 (21,900.00) (262,800.00) 0 Estimated Additional Patients Seen With EHR (101,531) (1,218,370) Total of Staff Time Saved (Minutes) (1,522,962.50) (18,275,550.00) Staff $ Savings ($1,396,048.96) ($16,752,587.50) Estimated Financial Benefit with Increased ($25,382,708.33) ($304,592,500.00) Patients Lumetra. EHR - Estimated Cost Savings Worksheet with additional inputs from Claudine Beron on implementation of VistA at 7 site facility 1/16/2009 page 9 Business Case Analysis for EHR D. Benefits of Reduced Storage Space using EHR Office Space Medical Records Storage Space Sq Ft 100 $ / Sq Ft $ Per Per Mth Mth Sq Ft 50 $ / Sq Ft Per Mth $ Per Mth Savings Per Year ($250.00) ($3,000.00) $5.00 $500.00 $5.00 $250.00 Total Monthly Savings/Cost of EHR ($27,782,757.29) * Values calculated with negative $ indicates cost saving in the indicated areas ($333,393,087.50) E. Cost of EMR Package Costs of Internet/Network Software Hardware Implementation Maintainance Training TOTAL EMR COST Total $212,000 $200,000 $425,000 $652,000 $15,000 $200,000 $1,492,000 Year 1 $17,667.00 $16,667.00 $17,708.00 $27,167.00 $625.00 $8,333.00 $88,167.00 Year 2 $8,833.00 $8,333.00 $17,708.00 $27,167.00 $625.00 $8,333.00 $70,999.00 Year 3 $5,889.00 $5,556.00 $11,806.00 $18,111.00 $417.00 $5,556.00 $47,335.00 Year 4 $4,417.00 $4,167.00 $8,854.00 $13,583.00 $313.00 $4,167.00 $35,501.00 Year 5 $3,533.00 $3,333.00 $7,083.00 $10,867.00 $250.00 $3,333.00 $28,399.00 Yearly Cost Savings of EHR After Monthly($333,304,920.50) ($333,322,088.50) ($333,345,752.50) ($333,357,586.50) ($333,364,688.50) Payment EHR of System Lumetra. EHR - Estimated Cost Savings Worksheet with additional inputs from Claudine Beron on implementation of VistA at 7 site facility 1/16/2009 page 10 Relationship of RIO and Complexity of Environments Lynn Harold Vogel, PhD. Finding Value from IT Investments: Exploring the Elusive ROI in Healthcare. Journal of Healthcare Information Management — Vol. 17, No. 4. October 14, 2003 1/16/2009 page 11 Common Approaches to ROI • The • 1. common approach to VistA: Identify the business processes affected by IT – these are all the standard operating procedures for the hospital, clinic or physician office • 2. Estimate current costs per transaction – estimate $1 per pull of each hardcopy file Estimate future cost per transaction after IT investment – estimate $.10 cents per transaction Estimate the net yearly cost savings – based on # of queries and patient bed size page 12 • 3. • 4. 1/16/2009 Overview of Proposed Method • Gather Objective Data. Gather information on cost of IT, use of IT and revenues of the organizational unit or the entire organization. Gather data on at least three longitudinal time periods or three cross-sectional units of organization within one time period. Verify Expected Associations. If returns can be attributed to IT investment, there must be an association among cost of IT, use of IT and revenues. Verify Causality. Test whether increased revenue has led to more IT use or vice versa. Calculate ROI. If IT investment can be assumed as the reason for growth in revenue, calculate a rate of return. page 13 • • • 1/16/2009 Gather Objective Data • Gather information on cost of IT, use of IT and revenues of the organizational unit or the entire organization. Gather data on at least three longitudinal time periods or three cross-sectional units of organization within one time period. Current – paper based office/clinic/hospital – • – Fixed • Salaries, Fringe, etc. • Office Supplies (Files, paper etc.) • Storage (cabinets, room space and off-site) • Legacy support Variable • Patient error rates • Lost records • Illegible records page 14 1/16/2009 Verify Expected Associations • If returns can be attributed to IT investment, there must be an association among cost of IT, use of IT and revenues. VistA Cost of IT – – – – • Hardware, Software, peripherals, printers Assessment and Change of Business Process Reengineering Legacy support, interfacing, transition On going Training for Clinical and Technical support Improved Patient Safety Reduce personnel cost Manage shortages of Nursing staff Do you intend on providing more services? Will the change impact revenue stream? page 15 • Use of IT – Why change? – – – • Revenue? – – 1/16/2009 Verify Causality • Test whether increased revenue has led to more IT use or vice versa Revenue • Increased – Is this system adding to revenue? If not, when? • Use – Are Doctors and Nurses using the System or are they reverting back to old system? 1/16/2009 page 16 Market Definition for VistA Healthcare Market Segments • The healthcare market has been categorized into four distinct segments. The four categories are: Market Segment 1: Hospital and Hospice Services Market Segment 2: Community Hospitals Market Segment 3: Medical Centers Market Segment 4: Health Networks • • • • 1/16/2009 page 18 Market 1 Hospital and Hospice Care This market segment is defined by organizations that provide general inpatient care and hospice services. The workforce is composed of clinicians that frequently practice within local areas. Clinicians are supported by skilled full time employees. These facilities rely upon a composite of consulting professionals and partnerships with larger hospitals. Organizational structures are flat with individuals performing several roles. Number of Facilities Capacity Typical Line of Business Average Length of Patient Stay Clinical Staff Composite Organizational Structure Net Revenue Median Payor Mix *Hospice: 35,000+ • Hospital Facilities: 2,267 • • • Inpatient Bed Range: 0 - 99 Skilled Nursing • Diagnostic Services • Consultation Services • • ALOS Range: Outpatient to Six Months Transitory Workforce: 250 Associated Staff - Consulting Physicians - Certified Nurse Aides - FTE Registered Nurses Inpatient Hospital Care • Community Based Care • • • Range: $15,000,000 to $90,000,000 Medicaid: 60% • Medicare: 20% • Managed Care: 10% • Commercial Insurance: 10% page 19 1/16/2009 * American Hospital Association Survey (USA Only): 2003 Market Profile 1 Hospital and Hospice Care These organizations are frequently challenged by health information management. Narrow sources of funding and revenue constraints dictate efficient care documentation for reimbursement, regulatory compliance and provider coordination. IT solutions should focus on core segments of clinical workflow. This market segment seeks solutions that are quickly implemented, highly supported and require limited customization. Stakeholders require that solutions enhance operations while allowing organizational attention to remain upon patient care. Vendors must offer full automation of the documentation with an integrated health data repository. Automated medication administration, transcription entry, results viewing and scheduling. The implementation of solutions should center upon small cross-trained teams on-site for brief periods. This team should then be supported by remotely located associates for limited software customization, workflow design, training and adoption management services. Hardware solutions should focus upon remote hosting solutions. Change Imperatives • Client Automation Requirements • Electronic Medical Record - Clinical Documentation - Medication Administration - Results Documentation - Scheduling Prioritized Selection Criteria Cost Pricing Strategy • Core Functionalities • Reliable Solutions • Remote Hosting • Short Implementation • Complete IT Support • • Strategic Objectives Optimize Financial Management • Increase Documentation Compliance • Coordinate Care • • Standardize Documentati on Increase Information Access Coordinate Providers 1/16/2009 page 20 Market 2 Community Hospitals The market segment is defined by small community hospitals that provide general practice care to communities within a region. The clinical workforce is stable with low turnover and is composed of full time physicians and support staff. The facilities serve as a central base for medical services in support of area clinics and community based care. Number of Facilities Capacity Typical Lines of Business • • • *Community Hospitals: 2,739 Inpatient Bed Range: 100 - 299 General Medicine • Emergency Services • • Average Length of Stay Clinical Staff Composite ALOS Range: 4.2 to 8 days Stable Work Force: 250 - 800 FTE - FT Physicians - FTE Registered Nurses - FTE Ancillary Staff Organizational Structure Net Revenue Median Payor Mix Full In-House Ancillary Services • Remotely Located Clinics • Coordinated Hospice Care • • Range: $90,000,000 to $125,000,000 - Commercial Insurance: 40% - Medicare: 30% - Managed Care: 25% - Medicaid: 5% 1/16/2009 * American Hospital Association Survey (USA Only): 2003 page 21 Market Profile 2 Community Hospitals The dominant challenges of these organizations is the centralization of health information, staff productivity, treatment coordination and financial management. Departments require access to patient treatment information to standardize and communicate patient care. Emphasis is placed upon departmental specific functionality. Treatment documentation must enhance productivity while facilitating revenue capture. Vendor solutions should focus on disciplinary workflow, orders management, results/image viewing, financial management and automated interdepartmental workflow. Stakeholders value process re-design and comprehensive IT support that establishes internal expertise. The implementation teams should work on-site for limited periods to collect data on workflow design, software customization, stakeholder engagement and training. Hardware solutions should offer on-site solutions only. Change Imperatives • Client Automation Requirements • Prioritized Selection Criteria Cost / Pricing Strategy • Cross Departmental Solutions • Customization • Implementation Methodology • IT Support Model • Strategic Objectives Increased Productivity • Financial Management • Documentation Compliance • • • • • Decrease Documentati on Time Increase Compliance Centralize Information Coordinate Departments Optimize Revenue Electronic Medical Record - Documentation Templates - Electronic Medication Administration Record (EMAR) - Results automation - Messaging - Deficiency Reporting - Charge Capture 1/16/2009 page 22 Market 3 Medical Centers The market segment is defined by large hospitals within metropolitan areas. A full spectrum of patient care is offered. These facilities have frequently undergone merger and integration into regional health networks. Segments of the clinical workforce are prone to turnover and are defined by specialized areas of expertise. Extensive provider partnerships are formed to offer patients comprehensive services. Management organization is hierarchal with specialized support departments. Executive stakeholders value scaleable technology with vision. Number of Facilities Capacity Typical Lines of Business • • • *Medical Centers: 539 Inpatient Bed Range: 300 - 499 Highly Specialized Areas: - Oncology - Cardiology - Surgery - Pediatrics ALOS: 5.6 Days Dynamic Workforce: 800 – 1,500FTE - Physicians - Ancillary Services - Registered Nurses - Specialized Clinical Staff Average Length of Stay Clinical Staff Composite • • Organizational Structure Net Revenue Median Payor Mix - Ancillary Services - Specialized Clinics - Remote Outpatient Clinics • Range: $125,000,000 to $200,000,000 - Medicare: 20% - Medicaid: 10% - Commercial Insurance: 50% - Managed Care: 20% 1/16/2009 * American Hospital Association Survey (USA Only): 2003 page 23 Market Profile 3 Medical Centers Organizations within this segment are focused upon streamlining workflow within departments, standardization of care, integration of treatment data and the automation of financial information. The highly siloed departments within these organizations challenge the standardization and continuity of care across organizational boundaries. Frequent bottlenecks occur in the communication and formatting of treatment and financial data. Merger processes frequently cause fragmentation of organizational processes. Vendor solutions should focus upon solutions that standardize and automate discipline specific workflow across departments and facilities. A centralized data repository with a standardized user interface must be accessible regardless of location. Departmental hardware must be interfaced to an EHR solutions for automated data capture. The implementation approach should utilize a team of specialized clinical experts and project management onsite for extended periods to perform workflow design, system customization and configuration and adoption management services. Change Imperatives • • • • • Client Automation Requirements CPOE - Order Alerts - E Signature • Electronic Medical Record - Documentation Templates - EMAR - Results Documentation - Charge Capture - Device Interface • Prioritized Selection Criteria Scaleable Vision • Enterprise Solutions • Cost / Pricing Strategy • Reference Sites • Technology/Chan ge Management • Service and Support • Strategic Objectives Increase Productivity • Standardize Care • Increase Revenue • Maximize Information Management • Streamline Processes Integrate Treatment Data Automate Workflow Increase Access Facilitate Communication 1/16/2009 page 24 Market 4 Health Networks The market segment is defined by full spectrum health centers that are regionally and nationally for specific areas of clinical excellence. These providers are organized within large health maintenance networks and teaching organizations. The hierarchal organization contains significant specialization within clinical and support silos. Turnover of staff is significant due to teaching functions and the broad lines of business within competitive markets. Number of Facilities Capacity Typical Lines of Business • • • *Health Networks: 249 Inpatient Beds: 500+ Nationally/Regionally Recognized: - Cardiology - Research - Oncology - Surgery - Teaching - Neurology ALOS 4.2 Days Dynamic Workforce: 1,500+ - Physicians - Specialized Clinical Disciplines - Registered Nurses - Research and Teaching Staff - Allied Clinical Disciplines Facilities are remotely based - Inpatient Beds - Universities - Ancillary Services - Support Facilities - Outpatient Clinics Range: $200,000,000+ Average Length of Stay Clinical Staff Composite • • Organizational Structure • Net Revenue Median Payor Mix • - Commercial Insurance: 35% - Medicare: 20% - Managed Care: 30% - Medicaid: 15% * American Hospital Association Survey (USA Only): 2003 page 25 1/16/2009 Market Profile 4 Health Networks Organizational challenges center around the competing objectives within the large hospital departments. Departmental siloes fragment workflow across departments. This results in the constriction of patient treatment information, continuity of care and standardization of processes. IT focus is placed upon solutions that seamlessly transmit data and automate interdepartmental workflow. Integrated solutions must demonstrate the flexibility to address multiple departmental objectives such as capturing charges while facilitating teaching and care documentation. Stakeholders require that solutions address workflow issues within the framework of a clear return on investment model. These organizations prefer to own initiatives with internal IT expertise. Vendors must present a scaleable technological vision with clear implementation and change management strategies. Change Imperatives • • • • Client Automation Requirements Prioritized Selection Criteria Strategic Objectives • Streamline Workflow Facilitate Communication Maximize Revenue Decrease Documentation Time Increase Quality of Patient Care CPOE - Rules / Knowledge based - Order Alerts - E Signature • Electronic Medical Record - Image & Results Viewing - Device Interface • EMAR • Automated Administrative Reports • Remote / Wireless Access • Charge Capture / Authorization • Vision Solution Functionality • Cost Pricing Strategy • Implementati on Methodology • Service / Support Model • Site References • • Process Standardizatio n • Organizational Integration • Financial Management • Increased Productivity • 1/16/2009 page 26 Cost Model for VistA TCO Model Assumptions Modeling Assumptions Beds Physicians Nurses Ancilliary Staff Total Clinican User ID's HIM user IDs Clerks IDs PA user IDs Total Non-Clinican User ID's Concurrent Users Concurrent User % Increase Licensure Increase Factor Net Revenue before expense Net Revenue before Expenses Small 200 150 450 100 700 5 50 15 70 770 200 Medium 425 300 900 150 1350 10 88 25 123 1473 368 84.1% 116.8% Large 725 600 1575 225 2400 18 150 35 203 2603 651 225.4% 167.6% 100.0% $125,000,000 Small $200,000,000 Medium $325,000,000 Large page 28 1/16/2009 Small Hospital TCO Comparison Hospital Size small Cerner Total One-Time Software Costs Total One-Time Implementation Costs Total One-Time Vendor Support Costs Total Ongoing Client Support Costs Total Hospital Revenue (4 years only) Operating Budget Ongoing Costs as % of Operating Budget $1,834,901 IDX $2,847,311 Epic $2,778,311 QuadraMed $1,584,063 Average $2,261,146.50 Minus -25% $1,695,859.88 Plus 25% $2,826,433.13 $5,338,732 $5,570,345 $5,570,345 $3,770,633 $5,062,513.75 $3,796,885.31 $6,328,142.19 $800,048 $1,160,000 $9,133,681 $1,571,884 $1,160,000 $11,149,540 $1,458,879 $1,160,000 $10,967,535 $ $464,355 $1,160,000 6,979,051 $1,073,791.50 $1,160,000.00 $9,557,451.75 $805,343.63 $870,000.00 $7,168,088.81 $1,342,239.38 $1,450,000.00 $5,376,066.61 $500,000,000 $500,000,000 $500,000,000 $475,000,000 $475,000,000 $475,000,000 $500,000,000 $475,000,000 $500,000,000 $475,000,000 $500,000,000 $475,000,000 $500,000,000 $475,000,000 0.41% 0.58% 0.55% 0.34% 0.47% 0.35% 0.59% 1/16/2009 page 29 Medium Hospital TCO Comparison Hospital Size medium Cerner Total One-Time Software Costs Total One-Time Implementation Costs Total One-Time Vendor Support Costs Total Ongoing Client Support Costs Total $2,120,194 $7,623,151 IDX $3,264,444 $7,907,089 Epic $3,201,754 $7,907,089 QuadraMed Average Minus -25% Plus 25% $1,806,573 $2,598,241.25 $1,948,680.94 $3,247,801.56 $5,657,449 $7,273,694.50 $5,455,270.88 $9,092,118.13 $800,048 $3,040,000 $13,583,393 $1,571,884 $3,040,000 $15,783,417 $1,458,879 $464,355 $1,073,791.50 $3,040,000 $13,985,727 $805,343.63 $1,342,239.38 $2,280,000 $10,489,295 $3,800,000 $17,482,159 $3,040,000 $3,040,000 $15,607,722 $ 10,968,377 Hospital Revenue (4 years only) $800,000,000 $800,000,000 $800,000,000 Operating Budget $760,000,000 $760,000,000 $760,000,000 Ongoing Costs as % of Operating Budget 0.51% 0.61% 0.59% $800,000,000 $760,000,000 0.46% $800,000,000 $760,000,000 0.54% $800,000,000 $760,000,000 0.41% $800,000,000 $760,000,000 0.68% 1/16/2009 page 30 Large Hospital TCO Comparison Hospital Size large Cerner Total One-Time Software Costs Total One-Time Implementation Costs Total One-Time Vendor Support Costs Total Ongoing Client Support Costs Total $2,981,372 $10,587,278 IDX $4,523,592 $10,609,591 Epic $4,479,948 $10,609,591 QuadraMed $2,478,238 $7,826,371 Average $3,615,787.50 $9,908,207.75 Minus -25% $2,711,840.63 Plus 25% $4,519,734.38 $7,431,155.81 $12,385,259.69 $800,048 $5,480,000 $19,848,698 $1,571,884 $5,480,000 $22,185,067 $1,458,879 $5,480,000 $22,028,418 $ $464,355 $5,480,000 16,248,964 $1,073,791.50 $5,480,000 $20,077,787 $805,343.63 $4,110,000 $15,058,340 $1,342,239.38 $6,850,000 $25,097,233 Hospital Revenue (4 years only) $1,300,000,000 $1,300,000,000 $1,300,000,000 $1,300,000,000 $1,300,000,000 $1,300,000,000 $1,300,000,000 Operating Budget $1,235,000,000 $1,235,000,000 $1,235,000,000 $1,235,000,000 $1,235,000,000 $1,235,000,000 $1,235,000,000 Ongoing Costs as % of Operating Budget 0.51% 0.57% 0.56% 0.48% 0.53% 0.40% 0.66% 1/16/2009 page 31 Contacts Claudine Beron, PMP Initiate Solutions, LLC 703-880-7365 703-599-1203 cell claudine.beron@initiatesolutions.com 1/16/2009 page 32 VistA Links VistA-CPRS Demo - http://www1.va.gov/CPRSdemo/ CMS - VistA Office EHR – http://www.cms.hhs.gov/quality/pfqi.asp#Vista-Office%20EHR Indian Health - RPMS - http://www.ihs.gov/Cio/RPMS/index.cfm DoD - CHCS http://www.tricare.osd.mil/peo/citpo/projects.htm Pacific Hui - http://www.pacifichui.org/ WorldVistA - http://www.worldvista.org Hardharts.org - http://www.hardhats.org/ Vista Software Alliance- http://www.vistasoftware.org 1/16/2009 page 33 VistA Article Links VistA - U.S. Department of Veterans Affairs National Scale Healthcare Information Systems (HIS), International Journal of Medical Informatics, February, 2003. • http://www1.va.gov/cprsdemo/docs/VistA_Int_Jrnl_Article.pdf • The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care , The American Journal of Managed Care, November, 2004. • http://www1.va.gov/cprsdemo/docs/AJMCnovPrt2Perlin828to836.pdf • • • Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample , Annals of Internal Medicine, December, 2004. http://www1.va.gov/cprsdemo/docs/Internal_Medicine_Article_on_VistA. pdf The Best Care Anywhere , Washington Monthly, January/February, 2005 http://www1.va.gov/cprsdemo/docs/Article_Washington_Monthly_Jan_F eb_2005.doc • • 1/16/2009 page 34 VistA Reading 1. West; O‘Mahony, ―Contrasting Community Building in Sponsored and Community Founded Open Source Projects,‖ Proceedings of the 38th Annual Hawai‗I, International Conference on System Sciences, Waikoloa, Hawaii, January 3-6, 2005. http://opensource.mit.edu/papers/westomahony.pdf Goldstein, Ponkshe, Maduro, ―Profile of Increasing Use of OSS in the Federal Government and Healthcare‖ http://www.medicalalliances.com/downloads/files/Open_Source_SoftwareGovernment_and_Healthcare_White_Paper-Medical_Alliances_2.doc The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care , The American Journal of Managed Care, November, 2004. http://www1.va.gov/cprsdemo/docs/AJMCnovPrt2Perlin828to836.pdf Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample , Annals of Internal Medicine, December, 2004. http://www1.va.gov/cprsdemo/docs/Internal_Medicine_Article_on_VistA.pdf The Best Care Anywhere , Washington Monthly, January/February, 2005. http://www1.va.gov/cprsdemo/docs/Article_Washington_Monthly_Jan_Feb_2005.doc Brown, Lincoln, Groen, Kolodner, ―VistA – US Department of Veterans Affairs National Scale HIS,‖ International Journal of Medical Informatics. February 2003 http://www1.va.gov/cprsdemo/docs/VistA_Int_Jrnl_Article.pdf 2. 3. 4. 5. 6. 7. Munnecke, Tom, ―Personal Health: From Systems to Space,‖ July 19, 2002 1/16/2009 page 35 EHR and ROI Reading • Sharpening the Case for Returns on Investment from Clinical Information Systems, Kevin Featherly, Dave Garets, Mike Davis, Pat Wise and Pat Becker http://www.longwoods.com/product.php?productid=18656&cat=465&page=1 Medical Records in the Greater Los Angeles State Veterans Home: A Unique Opportunity to Improve Quality of care for May of 2006. Literally just scanned it, but could help us position for DC. Take a look. http://lewis.sppsr.ucla.edu/publications/studentreports/2006_TownsendEtAl.pdf#search=%22Doug%20Babcock%2C%20VHA%22 EHR and the Return on Investment. HIMSS http://www.himss.org/content/files/EHR-ROI.pdf#search=%22EHR%20ROI%22 Exploring the Elusive ROI in Healthcare http://www.himss.org/content/files/jhim/17-4/vogel.pdf Value Measurement and Return on Investment for EHRs. Doug Goldstein, Peter Groen. July 2006 http://www.hoise.com/vmw/06/articles/vmw/LV-VM-08-06-19.html Mark Leavitt, MD, PhD, FHIMSS. Case for HER in Small Physician Offices - Physician Office QIOSC National Call -- January 11, 2005 Current Return on Investment (ROI) Literature for EHRs in Small- to Medium-Sized Physician Offices. Lumetra http://www.providersedge.com/ehdocs/ehr_articles/Current_ROI_Literature_for_EHRs_in_Small_to_MediumSized_Physician_Practices.pdf#search=%22Current%20Return%20on%20Investment%20(ROI)%20Literature%20for%20EHRs%20in%20Sm all-%20to%20Medium-Sized%20Physician%20Offices%22 EHR Estimated Cost-Savings Worksheet. Lumetra http://www.sdfmc.org/ClassLibrary/Page/Information/DataInstances/226/Files/1176/Web_EHR_ROI_Estimated_Cost_Savings_Workshe et_Guide.pdf#search=%22EHR%20Estimated%20Cost-Savings%20Worksheet%22 50 Reasons to get an EHR: Quick tips from your connected colleagues will show you how EHRs change the way they work—for the better. Robert Lowes SENIOR EDITOR . http://www.cerner.com/public/filedownload.asp?LibraryID=17504 • • • • • • • • 1/16/2009 page 36 Questions? 1/16/2009 page 37