By Beth Ann Muthig, Product Analyst for HealthMEDX
By now you have heard the wonderful news that HealthMEDX Version 7.1.10 has received Full Product Certification by the Certification Commission for Health Information Technology (CCHIT) and for components for the ONC-ATCB 2011/2012 Certification of both eligible provider and hospital. The criteria support the Stage 1 meaningful use measures requirement to qualify eligible providers and hospitals for funding. This funding is not currently available for post acute care.
About three years ago, my boss said, “We have this project for you, you will love it; it will only take about one year and only about 15 % of your time, a walk in the park”. Well, it has been more like hiking the Appalachian Trail, which can be done by one person but much more rewarding surrounded by a great group of hikers!
Let me tell you about our trailblazers and the human side of our successful certification process. Certification was much more than just one team effort to prepare for this process; it was an effort that involves everyone who “touches” our product: every Vision user, every HealthMEDX employee and our Certification Managers from CCHIT played a role in bringing this project to such a successful conclusion. It was more than two years in the making, more than 5200 development hours, and more than 1400 hours of review, testing and dress rehearsals for the actual days of testing. I had the pleasure of shepherding HealthMEDX through the certification process from the early planning stages to post inspection with our wonderful team. It was certainly a life challenging event. One of my proudest moments was our day of actual testing; our core team of presenters was absolutely on script and made us all very proud at HealthMEDX to be represented by such fine individuals.
What were our top 10 lessons learned through this process?
- Take the process very seriously- it is not easy. Every round of CCHIT certification criteria, every NIST procedure for meaningful use bore close watching; every iteration had some material change that created a new development requirement. Some were minor tweaks, some required major rewrite of a component of our product, and some required new functionality that did not exist two years ago.
- Take opportunities to educate. We continue to educate the acute care world on terminology and concepts used in the post acute world, from concepts of integrated product line that serve both the needs of a continuing care retirement community with both home health and skilled nursing, to simple terms such as problem list in acute world is called diagnosis list in the post acute world.
- Security testing is demanding. The security and interoperability were some of the more rigorous aspects of certification from documenting all the detail we use to protect data in transit to demonstration. Clinical team members went from knowing how your heart works to knowing how to generate encryption hashes!
- Read the fine print. Testing procedures and interpretation of these testing procedures was critical; this impacted the dress rehearsals on our perceptions that we were showing the product correctly.
- Spend your time wisely. Time management of all the individuals contributing to the project was extremely important to allow timely follow up on specific expectations during this incredibly challenging project.
- Educate on the fine print. Detailed training guides with the new functionality were critical to the end user including rational for including in the new functionalities, such as Medication Reconciliation and the Continuity of Care Document.
- Rehearse! Dress rehearsal after dress rehearsals set the stage for a seamless test script execution with CCHIT both for CCHIT certification and Meaningful Use. Being a web-based desktop sharing application with the jurors was something needed practice because there would be no human eye contact to know how we were doing. Often we continued test scripts without any response from jurors.
- CCHIT Staff were always there. Responsiveness and the willingness of the staff at CCHIT to engage with us, to get questions answered, and their patience made the process so successful.
- Keys: Patience, dedication and professionalism were the winning combination.
- Deep Breath and get ready for 2013/2014 Testing!
HealthMEDX’ electronic health record (EHR) HealthMEDX Vision version 7.1.10 has passed Certification Commission for Health Information Technology (CCHIT®) long term post-acute care (LTPAC) inspection, and is a CCHIT Certified® 2011 LTPAC EHR with additional certification for both the Skilled Nursing Facility and Home Health.
HealthMEDX has completed the full certification process including verification of implementation at client sites. “Completing the full certification of HealthMEDX Vision was a top priority across our organization” stated Dan Cobb, Chief Technology Officer at HealthMEDX. “This has been an important focus for HealthMEDX and one we have plans to keep up with as new certification criteria become available in the future.”
This certification has been achieved not long after HealthMEDX Vision 7.1.10 received ONC-ATCB 2011/2012 certification. Details on this certification can be found at http://www.cchit.org/products/2011-2012/arrafinalruleeligibleprovider/3419.
Read the official announcement here.
In our last two posts, we have discussed the first five important questions to ask your current or potential EHR vendor. Today, we wrap up the series with the last few questions to consider.
6. How do you balance innovation, client needs and regulatory changes in your product?
Purchasing a software solution can be a substantial investment for any organization. Looking at the software provider’s ability to continue meeting organizational needs into the future will help ensure the investment has long-term value. Looking at the details behind the percent of staff or resources a software provider allocates to product development is an ideal way to gauge the likelihood the solution will keep the value. Further delving into exactly how a vendor addresses ongoing regulatory changes while also delivering continued product innovation will help as well. Asking about a recent regulatory change the industry has seen and how a vendor handled it is a perfect way to bring up the topic.
7. How do you assist novice or entry level users in becoming proficient quickly with the system?
Navigation is the one major issue new users face when trying to become proficient in a system. Asking a vendor how they address this key barrier is important. While training and reference materials are important, system interface and other tools can also assist with this need. Properly designed systems will create tools that allow a user to do nothing more than choose a process they want to complete within the system. If the system is designed appropriately, the solution should automatically navigate the user through the steps of the process they are completing and prompt them for the documentation or action needed.
8. What tools are available to the client to make system adjustments after implementation?
Even with proper detailed discovery, organizations will continue to grow and their needs will change with this growth. While a system can be designed with the intent to meet the needs of an organization at a specific point in time, no one can predict the exact future needs of a provider. To help ensure the solution will work in the long-term, investigate what tools and options are provided to make adjustments or changes in the future. If it is determined changes to forms or workflow within the system takes significant interaction from the vendor, budget expectations should be set with executive management to plan for these types of future needs. The ideal scenario is to find a product that provides clients the ability to make these types of changes with little to no vendor interaction.
If you would like more info, or would like to view a demo, please let us know!
Last week we discussed the first two important questions to ask your current or potential EHR Vendor. This week we continue the discussion with questions 3, 4, and 5.
3. How do you create enthusiastic end users to avoid resistance to change?
Establishing a system user is an easy endeavor. Install a system, provide training, and make sure the solution is operating. Those three steps ensure nothing more than organizational staff has a system to operate within. Creating end users who see real value in a software product and who will help bring others along in system utilization takes a different approach.
Software has seen significant advancements over the past few years regarding end user interaction. Smart systems will utilize information such as the user’s role in the organization to push information to the end user that is applicable. The ability to eliminate complex menu structures hiding functionality deep within a system also helps ensure users see benefit and not frustration with a system.
Most important of all, software providers play a pivotal role in end user adoption before the software is even installed. Providing a one-size-fits-all solution no longer works for the advanced world of today. Sitting down and asking the proper questions of a provider is critical to make sure the end product provided to the organization fits their specific needs.
4. How does the solution support a single, integrated, person centered record?
The core design of a solution should be investigated with any vendor to determine the support of a single record. Whether an organization supports multiple care settings or could support multiple settings in the future, is a key question. For example, if a long-term care organization is thinking about adding home care or community based services, a person centered record will be critical.
If a single record is not created for the patient or resident, limitations can be present in reporting and managing various aspects of the system across the organization. Having a longitudinal view of the person’s record that includes data from other systems is also critical to providing proper care. Missing information creates risk when care decisions are made. Understanding the steps users have to take to view a comprehensive record in the system is an important area to review in detail with any potential vendor.
Further understanding the tools and methods the vendor provides in connecting with other systems will help determine the full view of patient or resident data within the system. The ability for a system to interface with other applications through standard or proprietary methods is important to create and support a comprehensive record.
5. What is your objective during the discovery process?
When engaging in conversations with software providers regarding an organization’s needs, it’s important to know why said discussions are taking place. Proper discovery happens when the vendor takes a deep look at how an organization operates on a daily basis in every area. High level overviews of operations are important; however, lack of deeper understanding of an organization’s policies and procedures can lead to problems in the future.
Understanding a vendor’s objective during discovery will help outline the true level of detail they will take into account when providing the final solution. Vendors who look at numerous aspects of an organization’s business are more likely to provide a solution that will fit needs from the moment the system is live. Lack of proper investigation, discovery, and preparation up front can lead to issues and frustrations not long after implementation. This can cause end user dissatisfaction with the solution and can lead to employee resistance and lack of full realized value from the system.
Come back next week to read the final questions!
8 Things to Ask Your Vendor
The process of selecting an appropriate software solution for long-term, home care, or rehab providers can be challenging. Evaluating system functionality is an important aspect in choosing the appropriate software for your organization. Evaluating your prospective vendor’s preparedness to address ongoing changes to industry regulations, the rapid pace of innovation, and an established goal of 2014 for EHR should be of equal importance in the selection process.
The evaluation of a potential partner’s ability to address these types of issues doesn’t have to be complicated. Asking the appropriate questions of your vendor candidates will help determine their focus and readiness for the issues facing long-term and post-acute care in today’s market. Eight questions are provided below that should always be asked of a potential software partner in an effort to determine their readiness to handle the future. These questions can serve as discussion points between care providers and vendors to ensure a like-minded approach to the issues facing long-term and post-acute care.
1. How will you support our organization if we want to be part of an ACO (Accountable Care Organization) or HIE (Health Information Exchange)?
As part of the Medicare Shared Savings Program, ACO’s are a required component made available within the healthcare market. ACO’s are voluntarily established entities that must service a minimum population of 5,000 people. They are made up of multiple care entity types that work together to care for the outlined population. ACO’s will receive and distribute shared savings from the combined approach and focus on quality care. Additionally, they will share in repayment of any losses incurred from serving the population. Sixty-five quality measures are in place to determine the savings or losses each ACO will create. These quality measures will determine whether the ACO has to reimburse losses or enjoy the benefits of creating savings.
Software solutions will play a crucial role for organizations electing to participate in ACO’s. More specifically, participation in a HIE will be at the center of this role. As individuals move through the care continuum, each organization’s software will need to have the ability to share information across care settings and with participants in the ACO. The following capabilities should be provided by the software vendor in support of ACO participation:
2. What steps are you taking to ensure your solution meets industry standards for a certified EHR?
- Continuity of Care Document (CCD) for transfer of care
- Ability to feed an ACO-wide EHR or HIE
- Support and utilization of an ACO Master Patient Index (MPI) for the population
- Ability to produce Quality Measures data as required
- Tracking and reporting on cost and utilization data
With the growth of information technology in healthcare, the need for solution accreditation has grown as well. Recently, the Certification Commission for Health Information Technology (CCHIT) has expanded its focus beyond acute care EHR solutions to include long-term and post-acute care EHR certification. Various solutions within the industry are considered EHRs; however, CCHIT certification standards now exist to provide validity to these EHR functionality claims.
Discussing details with EHR vendors regarding their certification plans is important. Certification of an EHR by CCHIT standards ensures more than 400 criteria are met. Certification serves as a starting point for any solution claiming to be an EHR. This can save organizations time and resources to investigate systems for these critical components allowing providers to focus on analysis of the solution in other areas.
Come back next week to see what other questions you need to ask.
The only constant these days is change. This is true for the long-term and post acute care (LTPAC) health information technology (HIT) industry as well. The recently enacted Patient Protection and Affordable Care Act (HR 3590, a.k.a. the healthcare reform bill) contained a number of sections relevant to our industry. At the HealthMEDX User Group last month, I provided an outline of the extensive changes that are in store for us. A few examples: Grants will be available for long-term care HIT best practices demonstration and adoption. Payment bundling demonstrations will begin and pay for performance (called value based purchasing by CMS) will move closer to implementation. The bill seems to favor shifting patients from institutional care to home and community based care. Look for consolidation and collaboration among post acute providers as a result.
A remnant from 2009's ARRA Stimulus bill is the required study and report on EHR payment incentives for providers not receiving other incentive payments. The Secretary of Health & Human Services (HHS) is due to provide this report to Congress in June. The LTPAC stakeholder industry is working with HHS to express the importance of adoption incentives for LTPAC providers.
The MDS 3.0 is set to implement in October, however it remains to be seen whether nursing home reimbursement will be driven from RUG-III or RUG-IV. The healthcare reform bill delayed RUG-IV to 2011, but industry groups are lobbying for implementation this October.
LTPAC EHR certification for is in full swing. The Certification Commission for Health Information Technology (CCHIT) LTPAC workgroup has been hard at work for the past year, co-chaired by yours truly. Criteria will consist of core elements (applicable to certified home health, nursing facilities, inpatient rehab facilities, hospice, long-term acute care hospitals) plus criteria specific to certified home health and nursing facilities. Pilot testing for the criteria was conducted in May with publication of the criteria and test script scheduled for June. Starting in July, LTPAC vendors may begin applications to certify their applications. HealthMEDX is planning to certify Vision this summer.
Finally, mark your calendars for the 6th annual LTPAC Health IT Summit at the Hyatt Regency Baltimore Inner Harbor on June 7 and 8. This is the only conference that specifically focuses upon LTPAC HIT. An Interoperability Showcase is included, giving participants the opportunity to see the latest technology initiatives to connect systems and applications. It is a great venue to network with LTPAC HIT thought leaders and to keep up-to-date on recent and future developments. More information on the Summit can be found at http://www.ahima.org/events/ltchitsummit/. HealthMEDX will demonstrate standards-based data exchange in the Interoperability Showcase and I will be speaking in a general session on EHR certification and data exchange standards.
See you in Baltimore.
Dan Cobb, CTO, HealthMEDX