Health Information System Proposal

1

PROPOSAL

Health Information System Proposal

Sherry Hairgrove

December 08, 2016

1

PROPOSAL

Introduction

Today’s healthcare is shaped and impacted by the software and information technology that surrounds and supports the industry. Health information system refers to any system that captures, stores, manages, or transmits information related to the health of individuals or the activities of healthcare organizations. The software needed to support a successful and responsible healthcare organization is no different. There are five information systems that are indispensable to the success of an accountable healthcare organization: an electronic medical record (EMR), a health information exchange (HIE), an activity based costing (ABC), a patient reported outcomes (PRO), and an enterprise data warehouse (EDW).

Health information technology (HIT) and electronic health record (EHR) systems offer the ability to increase the quality of care, to improve efficiency and effectiveness in the healthcare delivery process, the capability to reduce errors and improve safety, and to reduce care related costs. The EHR system’s role within the healthcare organization is to improve patient care across the healthcare continuum by spanning multiple branches or departments and multiple patient care activities. EHR systems also have the ability to improve organizational operations, but it is crucial for the successful implementation of health information technology to understand the organization’s needs. This proposal outlines MEDENT and the benefits it can bring to the healthcare organization.

Recommendation

MEDENT was chosen after careful research and a survey of area healthcare organizations found that MEDENT is the most commonly used system for this area, while also being ranked in the top 50 EMR systems, in 2014, by Medical Economics magazine (Top 50 EHRs, 2014). MEDENT is a leading provider of practice management (PM) and electronic medical records (EMR) systems, who’s systems offer advanced scheduling, patient registration, medical billing, insurance claims submission to over 750 insurance companies, claims management reporting, and practice management within its collection of powerful tools. Providing fully functional EHR products since 1992 MEDENT accounted for over 60 percent of EMR systems used in the Buffalo, New York region, in 2009 (Bauer, & Bozard, 2009). A recognized leader in the healthcare practice management and information technology market, MEDENT offers meaningful use certified, all-in-one EHR, patient portal, and practice management systems. Research shows that MEDENT ranks in the top 50 of EHR systems, scoring 88 percent in meaningful use, 7.3 out of a possible 10 in overall physician satisfaction, and an overall 7.7 out of a possible 10 in technical support, clinical support, business measurements such as quality, efficiency, performance, and processes; and many other rating factors, among 4,600 surveyed users, across a variety of fields (Bendix, 2015). While another study in 2011, of 2,719 EHR users, shows MEDENT ranking among the top systems for ease of use, meaningful use, and customer satisfaction (Edsall, & Adler, 2011).

Surveying area users of MEDENT, it was found that the technology interfaces well with other outside systems, including many hospitals, lab companies, and laboratory information systems (LIS). In fact, in 2010, MEDENT partnered with Cardiac Science, a developer of automated external defibrillators (AED) and diagnostic cardiac monitoring devices that connect to EMRs and hospital information systems, to connect its customer base of more than 65,000 diagnostic monitoring devices with MEDENT systems, enabling a smooth transmission of test results (Cardiac and MEDENT, 2010). MEDENT helps to improve quality of patient care and administrative efficiency, by making patient data available to physicians within minutes of it being posted in hospital and laboratory systems; this improves physician decision-making and treatment plans. This eliminates the need to file physical paperwork in patient charts, while enabling the physician to compare results with previous results and patient health information; using built in analytical tools. This integration with outside resources and the use of available analytical tools will also reduce the time it takes to chart patient interactions.

Disadvantages

There are disadvantages to the implementation of MEDENT or any health information system (HIT), the cost of fully implementing the HIT system in the organization can be unaffordable, especially for small single provider healthcare organizations. Although, the Health Information Technology for Economic and Clinical Health (HITECH), a provision of the American Recovery and Reinvestment Act (ARRA) of 2009, provides incentives for the implementation of EHR systems, certain criteria must be met to qualify for these incentives and still the systems remain costly to implement, integrate, and maintain. The ARRA allocated $46 billion in funding towards the advancement and implementation of EHR technologies; and providers were eligible for ranging from $44,000 to $63,750 and hospitals were eligible to receive incentive payments up to $2 million, to encourage conversion EMRs and HIT.

In 2009 studies showed the cost to implement and EHR system in an average five-physician practice cost an estimated $162,000, with maintenance expenses of $85,000 for the first year (Fleming, Culler, McCorkle, Becker, & Ballard, 2010). These figures include the cost of vendor software, hardware costs, staff and physician training, costs of transferring patient information, and other factors. The direct costs of software, staff support, and quality improvement initiatives breaks down to about, $34,000 - $39,000 per physician. A summary of proposed MEDENT project costs for Cortland County Health Department, in 2013, estimates the total cost for the project to be about $45,347.00, before taxes. Of this $22,455 is allotted for MEDENT software, product licensing, and on-site training, but this estimate relies on Cortland County Health Department’s ability to use existing hardware and it will be the department’s responsibility to provide, support, and secure the wireless network that the EHR/HIT system will use (Community Computer Service, 2013).

These financial impacts can be daunting, especially for single physician practices, which assume this tremendous cost, but EHR/HIT systems have shown the potential to improve efficiency in the health care organization, through integrated scheduling systems, which link appointments, progress notes, coding, and claims. EHR systems allow for easier chart management, easier communication with staff, labs, clinicians, and even patients through portals and automated message systems, which translates to more efficient time management, reduction of paperwork, payments received quicker, and an increased patient flow; which increases revenue for the health care organization.

MEDENT continues to update products and expand its services offered to health care providers, which increases functionality and flexibility of the software. This expansion includes a partnership with dashboardMD to provide advanced reporting and reports distribution workflow. DashboardMD is a leading provider of cloud based clinical and financial analytics, and operational business-intelligence reporting solutions. This will improve performance management functions through powerful analytics and performance management reporting for small the small practice to large multi-specialty group practices. This enables health care organizations to make insightful and actionable business decisions, through simplifying the revenue cycle monitoring, report distribution, and analysis reporting, thus saving time and increasing revenue.

Surescripts Basic Messaging, and Communications are subscriptions services offered by MEDENT, which increase the EHR’s usability and the productivity and efficiency of the health care organization. By streamlining communication through instant and secure messaging coordination and collaboration among health care providers is improved allowing for enhanced patient care and greater efficiency. MEDENT, a recognized leader in the health care practice management computerization market, has also been certified meaningful use compliant (Goldzweig, Towfight, Maglione, & Shekelle, 2009). Adopting MEDENT will provide health care providers with the decision support tools needed to improve patient care, while also allowing patients control over their health records through patient portal access points, but also concerns over information security.

Information Security

Implementing information technology into the medical field promises to improve quality of care and improve organizational efficiency, but privacy issues and access to EHRs during a disaster, are two of the main concerns that many patients and health care organizations have about electronic health records. EHRs have the potential to keep medical information safe in the face of disaster, unlike paper records, which can be easily destroyed. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule also provides protections for all personally identifiable health information, also known as protected health information (PHI). HIPAA is also designed to give patients control over their personal medical information and gives specific guidelines over how medical records can be shared (Motiwalla & Li, 2013). The American Recovery and Reinvestment Act of 2009 (ARRA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) contained within the ARRA, require that all public and private healthcare providers implement and use electronic medical records (EMR) to maintain their existing Medicaid and Medicare reimbursement levels (Worzala, 2009). Under HIPAA, the Fair Information Practice Principles (FIPPs) enable rigorous management of PHI and assure patients that data privacy is maintained.

The increased use of Health Information for Economic and Clinical Health (HITECH) will create a more efficient and affordable health care environment. Training and support from the software system providers will increase staff efficiency and productivity. Ensuring that all staff are trained and up-to-date on current regulations will ensure that patient information is protected and remains confidential. MEDENT provide simple and secure messaging systems through Surescripts Basic Messaging and Communications, which allows for authenticated and encrypted messaging between health care providers, patients, and trusted recipients over the Internet. Surescripts is a subscription interface service that MEDENT offers, that is accredited through Direct Trusted Agent Accreditation Program (DTAAP), an accreditation program for health information service providers (HISPs) (Marketwired, 2013). Encryption, network monitoring, and firewalls are all important to maintaining security and privacy.

MEDENT has also partnered with IdenTrust Global Common to provide IGC and PKI certificates, which provide identity authentication and digital signing, as well as certificates for encryption. PKI stands for public-key infrastructure and is a comprehensive system which provides and manages public-key encryption and digital signature services. IdentTrust Global Common (IGC) offers digital certificates, which are cross-certified with the U.S. Federal Bridge Certification Authority, allowing interoperability with a wide range of systems and include authentication/digital signing and encryption certification (InfoSecurity Live, 2014). The IGC and PKI certificates provided by IndenTrust meet New York State’s requirements for electronic prescribing of all controlled and noncontrolled prescriptions. This ultimately minimizes medication errors and helps to prevent criminal activities, such as prescription forging or theft. IdenTrust will manage the identity proofing and issuance for MEDENT, which will in-turn provide security assurances for health care organizations and reassure users, patients, and investors that information remains secure.

Conclusion

The use of MEDENT for EHR and health information technology will improve the quality of care for patients, prevent medical errors, reduce health care costs, improve the efficiency of the health care organization by decreasing paperwork, and expand access to quality care for patients with the sharing of information through approved channels and coordination of patient care between providers. Information monitoring, diagnostic, communications, coordination and assistive technologies directly empower consumers and caregivers to pursue personal health, wellness and independence goals (Pratt, 2016).

MEDENT will be beneficial to the sharing and dissemination of electronic medical records (EMRs), while maintaining a commitment to patient confidentiality. Although, privacy and security is one of the biggest challenges facing healthcare organizations today MEDENT has partnered with outside vendors to offer many products, which enable health care organizations to create a product that fits their needs. Analysis of the detailed information contained within electronic medical records provides many advantages; including improvements in medical care, reduced costs, and reduction of medical errors, which also help increase revenue and reduce the potential for costly litigation for medical errors.

Web portals, databases, e-mail, and electronic applications (APPS), are expensive to implement, maintain, and secure, but also give the ability to process workloads more efficiently, but MEDENT will offer services that will help to integrate these processes. Management of valuable information cannot be delegated to a decentralized IT department that is isolated from the strategic planning of the company, instead IT needs to be integrated into the company workflow to avoid disruption of services, unanticipated outages and down time (Barone, & Shmerling, 2013).

Proposal for MEDENT
All prices are estimates; final project costs are subject to change
See Breakdown and Notes Below
Quantity / Product Description / Estimated Price
MEDENT SOFTWARE
MEDENT Practice Management System – Accounts Receivable Software
10 User/Workstation License
One Directory/One Tax ID/One Location / $7,500
MEDENT Office Appointment Software / $1,500
MEDENT Electronic Posting of Insurance Payments Module / $1,500
MEDENT Integrated Letters Module / $1,000
MEDENT In-Office E-Mail Module
10 User/Workstation License / $1,000
MEDENT Insurance Card Scan-In Module (1-5 Units) / $750
MEDENT HIPAA Digital Signature Module (1-5 Signature Pads) / $750
MEDENT EMR/EHR Electronic Medical Record/Electronic Health Record System
10 User/Workstation License / $7,500
MEDENT Imaging Module for scanning and In-Bound Faxing / $2,500
MEDENT Fax Module for Out-Bound/In-Bound Faxing / $2,500
On-Site and Internet based Software Setup, Consultation, Training:
70 Hours @ $125 per hour
Hours over estimated will be billed at $125 per hour / $8,750
Total:
This estimate for MEDENT Software and may change depending on hours billed for setup and training, or potential add-on Software / $35,250
MEDENT Server/Hardware
1 / Linux Network Operating System Cent O6 / No Charge
1 / IBM x Series 3300 M4 Server
Raid 1 Redundant Server / $5,000
1 / Server Color Monitor 17” / $700
1 / Smart-UPS Uninterruptible Power Supply / $500
1 / MEDENT Remote Online Backup Service / $1,000
1 / HP 1810-24G v2- Switch-managed
Filters network traffic and control to maintain optimum network / $500
1 / Acer-Enhanced Business System Faxing/Printing System / $1,000
2 / Port Digi high speed communication board
(fax modem connection) / $400
2 / MultiTech Fax Modems / $500
1 / Acer Wide Screen LCD Monitor, with speakers / $500
Total:
Estimated hardware costs. Estimate subject to change depending on hardware needed. All hardware the health care organization uses must be up-to-date and able to meet software requirements / $14,000
Estimated
Will Use Existing Wireless Access Point (client provided/supported)
*It is the responsibility of the client to provide and support the wireless network from the client provided hardware, to the MEDENT Server. All wireless security precaution will be the responsibility of the client
1 / Scan Shell Duplex Card Scanner / $500
1 / Topaz USB Signature Capture Pad / $1,200
1 / Fujitsu Scanpartner duplex scanner / $1,200
1 / Lexmark Laser Printer / $1,000
1 / Lexmark 550 Sheet Capacity Paper Drawer / $500
INSTALLATION
Installation including System Configuration/Testing Onsite Installation, Server Configuration, Onsite labor to install and interface existing equipment / $10,000
Total / $14,400
Please Note Taxes will be added to final pricing / $63,650
Estimated

System Support

Hardware: No charge for the first three months. After three months $175 per month for hardware maintenance on equipment purchased in this proposal and phone support for hardware, remote connectivity, and interface to the Linux Server and operation system.

MEDENT Remote Online Backup Service

No charge for the first three months. After three months $75 per month based on the proposed MEDENT License. The monthly charge is based on the number of Medent Licenses chosen.

Software

No charge for the first three months. After three months, monthly software support chages as follows:

MEDENT Practice Management System / $125
Office Appointments (Scheduling) / $30
Electronic Posting / $20
Integrated Letters / $20
“In-Office” E-Mail / $20
Data Export / $20
MEDENT EMR/EHR / $125
Imaging / $30
Faxing / $15
Monthly Software Support Total / $405

Reference

Barone, J., M.D., & Shmerling, S., PhD. (2013). Strategically using IT resources in health care. Physician Executive, 39(1), 56-60, 62-3. Bendix, J. (2015). Best EHRs. Medical Economics, 92(20), 28-46.

Bauer, C., & Bozard, C. (2009). Health Information Exchanges. Health Management Technology, 30(2), 30.

Cardiac and MEDENT partner for EMR/EHR connectivity. (2010). Medical Device Daily, 14(9), 4.

Community Computer Service. (2013). Summary of proposed MEDENT project costs. In Cortland County Health Department. Retrieved December 10, 2016, from

DashboardMD. (2015). DashboardMD partners with MEDENT to provide turnkey healthcare analytics and advanced revenue cycle management reporting. In DashboardMD. Retrieved 10, 2016.

Edsall, R. L., & Adler, K. G. (2011). The 2011 EHR user satisfaction survey: Responses from 2719 family physicians. Family Practice Management, 18(4), 23-30.

Fleming, N. S., Culler, S. D., McCorkle, R., Becker, E. R., & Ballard, D. J. (2010). The financial and nonfinancial costs of implementing electronic health records in primary care practices. Health Affairs, 30(3) 481-489. doi:10.1377/hlthaff.2010.0768

Goldzweig, C. L., Towfight, A., Maglione, M., & Shekelle, P. G. (2009), Costs and benefits of health information technology: New trends from the literature. Health Affairs, 28W282-W293. doi:10.1377/hlthaff.28.2.w282