The following was written by me for the class I'm taking this quarter: Introduction to Informatics about the acquisition process for Electronic Medical Systems
As the owner of a small clinic with the fortune of receiving an information technology grant, I'm right in the middle of acquiring Electronic Medical Record/Practice Management System. Last July my office manager learned about an IT grant for small clinics in Washington offered by First Choice Health and Washington Health Information Technology Collaborative. I've talked about this with respect to other topics in this class. And this week I'll describe the process that my clinic staff and I are still in the middle of in order to implement our IT project funded by the grant. Like so many projects, I learned of the grant about two weeks before the grant proposal was due. Because of this, I had to hustle to put together a plan in the format required by the grant funding officers. The plan for the grant actually included most of the steps outlined in this week’s reading.
Establish a project steering committee and appoint the project manager.
My clinic has four staff members including me. Therefore we’re all part of the committee. As the owner and the one with the most experience with information technology, I’m the project manager. Throughout the project I could delegate roles and tasks among my staff members depending on my perception of their strengths and/or things I think will help them learn more about IT and contribute to growth of the employee.
Define project objectives and scope of analysis
Screen the marketplace and review vendor profiles
Determine system goals and prioritize requirementsThinking back to when I started the clinic in January of 2000, I had always wanted an integrated Electronic Medical record and practice management system. I've always enjoyed using technology and computers, and actually felt that they could be a big part of making my clinic more efficient. Initially, however, I only had three patients and a $10,000 loan to start the clinic. This kind of budget and optimism about the practice didn't allow for a lot of new technology or software. In fact, I brought in my computer from home and used my own creativity to develop forms for patient encounters, various letters, and patient statements. I consulted with a businessman that had started my previous employer’s clinic about billing and scheduling software, and because it was an extremely inexpensive but functional non-windows program, I purchased it.
Over the next few years, I kept my eye out for interesting new ways to integrate technology into the clinic. My home computer was replaced by a small network that I setup myself, consisting of a computer at the front desk, and one for my medical assistant and myself. I developed forms using Omniform (software that allows development of forms that include check boxes and pull-down menus, etc). I toyed with an old laptop computer for my house calls, but found it inconvenient and bulky. I experimented with PDAs for when I was on call. And also tried out some free electronic tools such as Allscripts eRx. Occasionally I would do an Internet search for inexpensive practice management software and Electronic Medical records. But none of them seem to allow for the collaboration with my referral network that was a very high priority for me.
At one point I was approached by a very large group of pediatricians that had formed an alliance to pool resources such as purchasing supplies, contacting out for billing, as well as joining to use an integrated Electronic Medical record. I gave their offer a great deal of thought, and was really tempted to participate, but just couldn't give up my independence. So I turned them down. This was a good decision in retrospect, as their alliance fell apart within a few years.
I also talked with my son who is a programmer. He suggested that his programming company could develop custom software for our clinic if we wanted them to. Although this was intriguing, it didn’t make sense to me to reinvent the wheel.
So, although I had not formally gone through the process of developing a committee, determining priorities, sending out requests for proposal, etc, I had actually a good idea of what I wanted. My priorities are:
1. A system that integrates practice management (billing, coding, scheduling) with the medical record
2. The ability to collaborate with my referral network by sharing files and secure communication
3. The ability to access patient charts wherever patients are seen--for instance at a house call, in the clinic, or during a phone consultation
4. The ability to see lab results, x-ray, and test results as well as ER reports
5. The ability to allow patients families access to scheduling and some of their medical record
6. Tools such as evidence based protocols, algorithms, etc
7. Interface with the state immunization registry
8. The ability to customize documents
9. Good tech support available round the clock
This kind of system should eliminate some of the duplication of documentation that happens currently with my paper charting. But it shouldn't form an artificial barrier between me and my clients.
Considering hardware: the way I practice, I am on the ground interacting, playing with kids while they have their examination. Or unseated next to a mother at her home holding an infant, while helping her learn techniques for breastfeeding. So, a computer station attached to the wall or on the desk isn't going to cut it. I need a system that is very mobile and flexible. About six months ago I purchased a tablet computer for myself. It's got a touch screen, and the monitor swivels and lies flat so that I can use it just like the paper chart. I've played around with it in various situations doing patient care, and I think this is going to work. Using my Omni form pages, I'm able to chart easily on the floor next to kids as well as at house calls with newborns.
Develop and distribute Request For Proposal or Request For Information
Explore options for acquiring system
Evaluate vendor proposals
Conduct cost benefit analysis
Once I began to develop my plan for the IT grant, I consulted with a patient’s mom, and friend. She works in tech support at MultiCare for epic CareConnect. She introduced me to the director of the program at MultiCare. After explaining what I had in mind, and showing him around the clinic, he went back to MultiCare and proposed a demonstration project. Because my concept at the clinic includes expanding our developmental program to provide house calls, and we already provide house calls for newborns, he was intrigued. My clinic style is very casual and homelike. My staff and I work hard to ensure that families feel like they're part of my family. And the care we provide is very personal. So, along with our grant of $20,000 for IT, MultiCare epic CareConnect offered us deep discounts for their program.
Epic CareConnect is being used by Mary bridge children's hospital, as well as Mary bridge specialty clinics. So, it will enhance my ability to collaborate with my specialists with Email and integrated charting. Essentially my patients’ charts will follow them from my clinic to the specialist, the lab, x-ray, or the hospital. MultiCare calls it “one patient -one chart." They offer practice management in the form of integrated billing, coding, scheduling. They have decision making tools and customizable forms. After the first of the year they will have a portal to the state immunization registry so that when we enter immunizations, they will be automatically uploaded to the registry once a month. And they offer around the clock tech support.
Prepare summary report and recommendations
Conduct contract negotiations
The epic CareConnect team has come through and looked at our current hardware and made suggestions to bring us up to the system’s requirements. I reviewed the contract and when all of my questions were satisfied, signed it. We've researched hardware vendors and ordered new equipment--tablet PC's for everyone who does direct patient care (me and a medical assistant--and eventually another nurse practitioner), two new desktop PCs with more ram and processor speed for the receptionist and office manager, and a network laser printer that can handle multiple work group tasks such as prescriptions or patient handouts or billing. We are keeping our old desktop PCs and making them available for patients to use while at the office. And I'm sending one home with the receptionist who doesn't have her own computer at home, so that she'll be able to access the network remotely. Our old laptop will go home with my medical assistant so she can use it to access the network remotely. The office manager has a tablet PC like mine already for remote access.
We're setting up docking stations for the tablets in the lab and on our desktops. And we’re putting a large monitor in the lab to view x-rays. We're keeping our mobile printers for the house calls and for the lab. And we're keeping our all in one printer/fax/scanner. And we'll keep our existing network router both wired and wireless. All this hardware should arrive in the next week or so. And I'll have my work cut out for me as I transfer data and settings and set up the new network. If I need help, I have a tech support company that I can call in.
For security, the new tablets will have fingerprint password, a backup regular password, and LoJack. The desktops will have regular passwords. We expect that in the first months everything is going to take a little bit longer. For example we aren't transferring all of our paper information to the Electronic System. But we will be entering information such as demographics (if it's not already in the system) and problem lists. We plan to use the paper chart along with electronic chart for a while as well. And, until we're confident that were being paid, we'll be using the old billing system while testing the new one.
My committee members are all keeping blogs to document their experience during this time of change in the clinic. We have a large notebook that serves as our project repository. Once the new hardware is in, we’ll transfer that notebook contents to an electronic file. In about six months and at a year, I’m required to prepare a report to the grant committee. I expect to provide them with a summary of the project activities to that date and an evaluation of how things have gone. For my own information I have planned to continue evaluating our offices experiences with the EMR, as well as some research questions that I have about patient use and whether the project has met our goals.
Well, I got some wool felt at the Spring Fair a couple years ago and have been hanging onto it for just the right project. I have a jacket pattern that I'd really like to use it on. But I'm worried about ruining it with something so complicated. So I'm going to try these mittens first. 
