First, clarify the goals for your EHR implementation project. Exactly what information do you need to capture and what outputs do you expect in the way of reports or billing? This is especially important for federally qualified healthcare providers (FQHCs). Will you enter records only from the point of go-live with the new system, or do you plan to capture historical data as well? How much of your paper records will you plan to enter into the new system and how will they be entered, e.g. scan or data entry?

Identify the tasks you expect to handle through the EHR system such as electronic medical records (EMR), computerized physician order entry (CPOE), data transmission to pharmacies and other providers and billing. Do you expect to execute all these tasks immediately upon system implementation, or will you phase in some of the tasks?

Analyze business needs that should be factored into the selection criteria. What is the size of your practice? Are there specialty needs for your practice such as reporting requirements or considerations for your patient base such as disease prevalence, language, etc. Only if these considerations are taken into account will you achieve a satisfying EHR implementation.

Which software you are currently using that needs to interface with new applications. Identify functionalities of existing applications you need to guarantee are part of new applications and list functions that you need but do not currently have. Make a “wish list” for the new system and let everyone dream a little. Finally, prioritize the lists of requirements and wishes so that the most critical needs are captured in the application selection and so there is a criteria for determining trade-offs between functions, time, and cost when decision time comes.

And then, of course, develop the budget for your EHR implementation. Include direct costs such as hardware, software, and technical resources, and indirect costs such as IT policy management and data integrity and security. Determine how you will calculate return on investment (ROI) and any budgetary timelines that must be taken into account.

a. How can an MSP help make the selection process easier and more effective?

A Managed Service Provider (MSP) can help to simplify the very complex process of selecting software and vendors for an EHR implementation. An MSP provides one single point of contact as opposed to navigating a maze of multiple vendors. An MSP provides education to further inform health care administrators and become more informed consumers and decision makers.

An MSP is a non-biased partner that can help your organization understand and evaluate both the risks and rewards inherent in any health information technology (HIT) project and in the choice of applications. MSPs provide independent consultants who are not employees of an EHR development company and are not trying to sell a particular software system.

Your MSP can review the preparation you have done and help refine your criteria for selecting software. The MSP can evaluate current hardware and advise you of gaps in what will be needed for your new system. Managed Service Providers offer the infrastructure required to support new applications and data storage needs and can help you reduce capital expenditure for equipment.

An MSP will also assist you in evaluating and planning for the training needs of your staff. Many MSPs offer highly skilled training and on-going support.

Selecting and securing all the moving parts of HIT and an EHR system is a daunting task for any healthcare provider.  But this is an especially significant hurdle for small and medium sized organizations. The project will require huge investments of time and money. The final system will be in use for a long time. But healthcare administrators do not have to go it alone in an area that is not their expertise. A managed service provider is an invaluable partner in a project that will deliver many benefits and improve the quality of health care delivery for years to come.

References

Adler, Kenneth G. “How to Select an Electronic Health Record System.” Family Practice Managment. http://www.aafp.org/fpm/20050200/55howt.html. American Academy of Family Physicians, February 2005.

Electronic Health Records: Selection Guidelinesfor Health Centers. December 2008. October 2009 <http://www.hrsa.gov/healthit/ehrguidelines.htm>.

In September 2009, the Associated Press reported that “fewer than 10 percent of U.S. health care providers are using electronic medical records.” The push is on, however, for EHR implementation because of the prospect of cuts in Medicare and Medicaid payments to providers who cannot demonstrate “meaningful use” of HIT by 2014. How can the lessons learned by the providers who are using EHR help those who have yet to implement it?

Some of the lessons learned can be applied to health care organizations of all sizes. However, there are some challenges and benefits unique to small clinics, physician offices and for the smaller hospitals.

Of course one of the most often cited benefits of an electronic medical records (EMR) system is the elimination of paper records. Health care organizations of all sizes can save time and money when papers do not have to be filed and storage cabinets are no longer needed. If you are a healthcare provider currently using paper-based records, watch how much time it takes your staff to track and acquire those files throughout the day.  You may be surprised when you uncover the amount of time your staff spends playing “hide-and-seek.” Frankly, the implementation of EMR and its impact on reducing this amount time alone can many times justify the cost of EMR acquisition. But most important is the improved healthcare delivery with EMR implementation.

One of the challenges of a quality EHR implementation for all organizations, no matter what size, is the critical requirement for computer and network systems to be fast, flexible and reliable. And above all, these EHR systems require significant capital expense for software, hardware and training.  Because of this issue, a hospital and clinic can depend on Managed Service Providers (MSP) for their infrastructure. MSPs provide the equipment, maintenance, and support needed for a healthcare delivery system which cannot tolerate glitches or downtime without the cost of going it alone.

a. Lessons for the physician’s office and small clinic practice.

A case study of the EMR implementation at Denver’s Public Health STD Clinic offers several findings for the small clinic. An immense benefit of an EMR is that lab results are available in the exam room so that a clinician does not have to spend time and energy searching for them. Also, the entire patient history is available and can be searched electronically rather than clinic staff flipping through thick folders of paper to gather history and find information.

The Denver study faced a couple of challenges with a staff of generally inexperienced computer users and the entrenchment of established processes. At times, Clinic personnel did not have a high degree of computer literacy and skill, and were anxious about the need to adapt to the computerized EHR system. This required significant time and resources for staff computer and systems training. An MSP can facilitate a more reliable adoption process by supplementing software vendors with experienced computer trainers to bring clinic staff up to speed for the HIT implementation.

Another challenge identified by the Denver study was the need for consultants to thoroughly understand and be able to document the complex processes and workflow in the medical environment. Many MSPs utilize process redesign consultants that have the skill and experience required for this planning phase of the HIT project.

Financing is, of course, an issue raised by most small and medium healthcare providers. Many of these entities are publicly funded, non-profit organizations with chronic capital constraints. They are under particular pressure to show direct return on investment for expenditures and often rely on grant funding which is usually designated for direct patient care. While healthcare IT initiatives are proven to result in improved healthcare quality, it is accomplished in indirect way. Therefore, while cost is a consideration for all healthcare organizations, it is a disproportionate burden for the small and medium healthcare providers. The small practice will benefit greatly from the cost savings realized by engaging an MSP.

b. Lessons for hospitals

In a hospital setting, the immediate access to patient records provided by electronic health record (EHR) systems can make a critical difference in the quality of care. This is especially true in an emergency room setting where healthcare workers rely upon fast and reliable information to make urgent care decisions. Lack of patient history and drug records inhibits timely decision-making on care delivery. Even in non-emergency care, EHRs provide a great benefit in coordination of care between primary care providers, specialists and multiple provider practices.

When the National Health Service in England began the initiative to create a single EHR for every individual in its system, it found an obstacle with public and physician resistance to EHR implementation. Both health care providers and patients were concerned about the confidentiality of health records. Especially they felt threatened by the ease of communicating medical data and the access across provider organizations. MSPs provide an elevated level of security and data integrity that reduces the fears of both patients and providers.

A primary concern for hospitals is the complex nature of IT projects. Any information technology (IT) project has an incredible number of moving parts which must be managed in a systematic, incremental way. With the additional complexity that a healthcare information technology project adds, a Managed Service Provider can be an important resource in assisting IT Managers at overseeing the implementation of these difficult projects.

The American Hospital Association (AHA) has expressed concern about the federal government’s aggressive timetable for implementing HIT. In a letter to the HIT Policy Committee the AHA stated, “…this aggressive schedule could threaten patient safety and quality of care as hospitals are forced to shift to a mere technical implementation of technology rather than the more methodical process of implementing HIT system changes…” The AHA recognizes the change management involved in an HIT project and that the rush to implement may jeopardize the quality of the projects implemented. If hospitals must meet the 2014 timeframe for achieving “meaningful use” of HIT in order to avoid financial penalties, MSPs are valuable partners and managers of these fast-track projects.

Whether a health care organization is small or large, there are many challenges and benefits in a HIT implementation. A Managed Service Provider helps reduce the risks and helps the healthcare provider reap the rewards of an EHR project. MSPs deliver security, reliability and quality to the health care organization seeking to improve its health care delivery.

Works Cited

AHA Letter to HIT Policy Committee. Washington: American Hospital Association, 26 June 2009.

Granger, Richard. Study of Health IT in Government: Challenges to achieving the vision of a universal electronic health record. Intergovernmental Advisory Board. Washington: American Council for Technology, 2006.

McEwen, L. Dean, Brandy, Subiadur, Julie Mitchell and Arthur Davidson. Implementation of an Electronic Medical Record in a County Public Health STD Clinic. Health IT in Government. Intergovernmental Advisory Board American Council for Technology. Washington, 2006.

Moiduddin, Adil and Jonathan Moore. “The Underserved and Health Information Technology: Issues and Opportunities.” Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services, 2008.

Twiddy, David. “Work begins on national e-health record network.” 30 September 2009. Washington Post.com. Associated Press. October 2009 <http://www.washingtonpost.com/wp-dyn/content/article/2009/09/30/AR2009093000522.html>.

What is happening with “Cloud Computing?”

Managed Service Providers make services available through cloud computing. Today’s telecommunications infrastructure provides cost-effective connections to high bandwidth services, providing access to shared resources. Cloud computing can be thought of as a time-share IT department. The cost of quality equipment, competent personnel and computing power is shared with other organizations rather than consuming a significant portion of organizational budgets.

The most well-known and simplest definition of managed service is web hosting. But web hosting only scratches the surface of what MSPs can provide. Perhaps even more valuable, especially to healthcare organizations, is an MSP’s ability to offer application hosting such as email, word processing, spreadsheet and electronic health records, SQL database hosting and secure data storage.

Cloud computing is a fairly new term and is a rapidly growing trend. The 2009 Cloud Computing Trends Report produced by Hosting.com in February of 2009, reported that, “Compared to a September 2008 study by InformationWeek, the likelihood of organizations to deliver their IT services on a Cloud platform has doubled.”

Cloud computing is increasing global access to information, as well as providing platforms for collaboration. Rather than colleagues fighting disparate computer systems and software programs with unworkable interfaces, they can collaborate seamlessly through broadband connections. Access to software functionality and data is often accomplished with browser-enabled role-based portals by users who need little more in the way of skills than surfing the web. The learning curve for complicated software has been flattened.

In addition to widening access and simplifying use of computer power, cloud computing is improving mobile access to data. There is increasing physician adoption for handheld devices which allow access to pharmaceutical and other references. Administrators and other staff can perform business management functions from anywhere. More and more, health care providers will be un-tethered from desktop computing stations without sacrificing functionality.

Managed Service Providers open the door to leveraging the benefits of the virtual cloud. Many provide SaaS (Software as a Service) as a means of deploying computer applications. This is a more flexible and economical model than the typical purchase of software for each workstation in the organization.

What are pitfalls experienced with IT support by small and medium healthcare providers?

The limitation of traditional IT support experienced by small and medium healthcare providers is eliminated with the implementation of a managed service platform. The sheer volume of areas competing for the attention of healthcare IT personnel, the myriad of tasks to be done, and the amount of knowledge needed to provide support is overwhelming to many IT departments. Healthcare administrators can use IT personnel as IT knowledge managers to assist with the business management requirements of information instead of technicians tasked to keep systems and infrastructure working.  This knowledge is needed in a number of areas that can and have become specializations such as network administration, data mining, reporting, data security, process design, and more. The struggle to stay abreast of new technologies can then be put in the hands of a MSP.

Many health care organizations, especially small and rural providers, struggle with a scarcity of knowledgeable and competent IT resources. Add in salary for healthcare IT personnel, and cost alone becomes a huge obstacle for these healthcare providers.  The American Hospital Association reports that cost is the most commonly cited barrier to greater information technology adoption in hospitals.

And then there is the need for the healthcare IT department to be continually available and on-call, especially in the hospital setting. Quality health care cannot be delivered with intermittent computer services and network glitches. Managed Service Providers can provide 24/7 availability for issues resolution and with hardware redundancy for failure recovery, availability is built-in.

What additional issues does implementing an EHR cause?

Security is the top concern for healthcare organizations whether they have internal IT departments or outsourced Managed Service Providers. Privacy of personal health care records, whether paper or electronic, is a primary responsibility of health care providers. MSPs fundamentally provide secure network environments and focus on data security. A MSP’s data storage service is the most secure means of storage a small and medium healthcare provider can afford.  No longer is data stored on vulnerable premise based systems or accessible laptops.  MSPs offer data is storage in highly secure data centers with limited access, redundant network and power systems and 24/7 monitoring.  The risk of highly sensitive data being stolen, misplaced or accidentally deleted is significantly less when an MSP provides the storage. Frankly, the cost of deploying the level of security available from a MSP is just too high for any small and medium healthcare provider to implement within their own private facility.

As the healthcare industry moves toward a consistent standard for communicating with one another, the interface of systems and programs becomes a huge issue. The lack of technical standards for transmission of data is a significant obstacle. Interoperability of systems allowing the sharing of records must be achieved for successful EHR implementation, yet the cost of constructing these systems are much too high for small and medium healthcare providers. Progress is being made in this area, thanks to recent government legislation and financial assistance for eventual adoption of electronic health records.  However, the focus of these efforts are on the information technology adoption only. The financial impact to small and medium healthcare providers for the on-going management and maintenance of these highly technical information systems are a burden on already stressed organizations.

Health care organizations need a trusted, knowledgeable provider of IT services and support with an infrastructure capable of meeting their many complex needs. Managed Service Providers can fulfill this need.

Works Cited

“2009 Cloud Computing Trends Report.” Hosting.Com, 2009.

“Continued Progress Hospital Use of Information Technology.” American Hospital Association, 2007.

Managed Services Providers provide expertise in network administration, monitoring, data storage and technical assistance. These services, sometimes referred to as IaaS, or Infrastructure as a Service, are usually offered on a pay for service basis. This is an advantage to healthcare administrators in budgeting because IT costs are known and predictable. Since much of this work can be done remotely, healthcare providers located in hard to reach areas can also take advantage of this service.  A MSP makes it possible for any healthcare provider to have cost effective access to the highest level of expertise, technology and support.

Since salaries for IT Directors range from $75,000 to $125,000 or more annually, many healthcare organizations cannot afford their own in-house staff. Independent provider practices, behavioral health clinics, and rural health organizations can be hindered by budget, geography and availability of resources in securing the IT staff and skills needed to maintain hardware, oversee networks and manage data storage, especially electronic health records.

MSPs can supplement healthcare IT departments in larger organizations by providing additional personnel, expertise and equipment. Many providers offer round-the-clock network monitoring services and can be contracted to take over during off hours. This extends the availability of network resources without hiring additional personnel saving considerable costs.

Engaging a Managed Service Provider can reduce capital expenditures for IT infrastructure and hardware. The perpetual cycle of upgrading hardware and operating software is the responsibility of the MSP rather than the healthcare provider. Thus, healthcare administrators will realize a greater and a faster ROI (return on investment) for their IT dollars.

Another challenge for IT is maintaining knowledge and skills on ever-evolving technology in computers, servers, operating systems, and other platforms. Utilizing an MSP allows healthcare organizations to focus on the business of providing quality healthcare rather than chasing the latest technological advances. Rather than focusing on supporting the infrastructure for accomplishing those initiatives, in-house IT personnel can be a vital participant in ongoing initiatives to improve health care delivery and quality,

As healthcare organizations initiate and optimize IT technologies such as Electronic Health Records (EHR) and Computerized Physician Order Entry (CPOE), Managed Service Providers become an even more valuable resource. MSPs offer consulting on network needs such as servers, processing capacity and data storage. An MSP is an integral technical partner in EHR implementations. They can provide storage for the massive amount of data and images involved in electronic health records. Data storage is an integral part of any IT initiative, MAP services can provide for redundancy of data and be part of a robust backup and disaster recovery plan in all facets of the IT infrastructure including, email, business applications and EHR implementations.

Many MSPs also provide Software as a Service (SaaS), offering programs to their clients on a subscription basis. Rather than having to purchase expensive software applications that may be sparingly used, the healthcare provider pays for only the applications needed and used. They have access to a wider range of applications and will certainly have more flexibility in finding programs most suitable to their needs. Also, the continual cycle of upgrading to the newest software version is eliminated since the MSP makes this investment.

The key benefits offered by IT Managed Service Providers to healthcare providers and administrators are:

• Proactive monitoring
  • HIPAA Compliance
  • Network Integrity
  • Disaster Recovery
  • Security
• Single source for all IT and telecommunications
• Proactive Service and Maintenance
  • Eliminate or minimize downtime with defined service levels
• Costs known and stable
• Significantly Less Capital Expenditure for IT Systems
• Significantly Less Cost of On-going Service and Management

An IT Managed Service Provider can indeed be an invaluable partner to healthcare organizations large and small,  Whether as a supplement to resident IT departments or as an outsourced provider of network needs, MSPs are an ally to the healthcare administrator overseeing the effort to provide quality healthcare.

Works Cited

Erickson, Jonathan. Cloud Computing and Virtualization. 23 June 2008. 30 September 2009 <http://www.ddj.com/hpc-high-performance-computing/208800138>.

Managed services. 2 October 2009. <http://en.wikipedia.org/wiki/Managed_services>.

Top 10 Jobs in Information Technology. 1 October 2009. 1 October 2009 <http://www.careerbuilder.com/Article/CB-774-Who-Is-Hiring-Top-10-Jobs-in-Information-Technology>.