Created: 9/16/2014 Page 7 of 7

YCS PERFORMANCE EVALUATION FORM

Revised: Electronic Health Records (EHR) Syst. Implementation Mgr/Admin.

EMPLOYEE NAME: ______FACILITY/PROGRAM (specify): ______

REVIEWER NAME: ______REVIEWER TITLE: ______

EVALUATION PERIOD: 90 Day Annual Job Change ………..TIME FRAME OF EVAL: From ______To ______

The age of the clients served: ___ under 1 year; ___ 1-4 yrs; ___ 5-12 yrs; ___13-17 yrs; ___ 18-22 yrs ; ____ 23+ yrs ____ n/a

/ SOURCE
OF DATA*
(abbreviation) / RATING** / COMMENTS
(If necessary, attach additional sheets) /
DUTIES AND RESPONSIBILITIES
Serves as the lead project manager for the effective launch of the Qualifacts Carelogic EHR system implementation.
Gives feedback to seven (7) Steering Committee, comprised of COO, Sr. VP and Medical Director, CFO, VP of IT, VP of Contracts and Compliance, Director of Research, Director Human Resources with first line of reporting to COO.
Develops overall project plan, in conjunction with Qualifacts contractual timetable, including key milestone dates
Assists the Steering Committee in identifying stakeholder leadership from Medical Services, Residential Services, Mental Health Clinics, Schools, Accounting, Finance, Research and other functional areas as determined appropriate.
Monitors key stakeholders’ progress against project plan.
Moderates all necessary project meetings and conference calls and coordinate distribution of all materials to meetings.
Identifies any delays against plan or any other risks to go live on required schedule and communicate with Steering Committee members.
Develops corrective actions to ensure timely implementation.
Coordinates with Qualifacts project management team.
Plans and coordinates system testing efforts associated with new implementation and ongoing maintenance.
Ensures monitoring of all EHR System configuration setups, updates, revisions, modifications and maintenance in conjunction with agency IT Department.
Oversees all EHR Administrators of YCS programs and affiliated agencies.
Demonstrates knowledge of technical processes clinical workflow patterns to interpret data and advances use of the EHR.
Provides ongoing technical and clinical support to the EHR users.
Establishes relationships with affiliated agencies.
Reviews and validates business requirements with other applicable team members.
Acts as primary functional contact for YCS during pre and post implementation.
Provides technical assistance to design custom EHR reports to meet the data needs of the agency and its programs.
Diagrams program workflows.
Acts as an agency contact for Qualifacts Support Team.
Leads CareLogic implementation teams for new programs within YCS and affiliated agencies.
Conducts train the trainer workshops for newly identified EHR trainers, as needed.
Trains EHR trainers on the new features in the EHR, as needed.
Ensures all application documentation remains current.
Conducts other duties and tasks as directed by Manager.
Trains end-users, as necessary.
Provides on-call services as necessary.
Ensures compliance with agency and other regulatory requirements.
Manages data conversion efforts for the project.
Acts as Subject Matter Expert throughout project.
GOAL(S)
Accomplished assigned goal(s) for the preceding year.
CORE COMPETENCY TRAINING
Core competency trainings completed
(If 100% of core competency trainings are completed, the score is 4
If any of the core competencies are not completed, the score is 1
There are no scores of 2 or 3 for this item)
CORE VALUES (All Staff)
ATTENDENCE & PUNCTUALITY
Regularly present and punctual
Calls supervisor in advance if unable to report to work
DEPENDABILITY/ FLEXIBILITY
Completes assignments on time and carries out instructions
Performs well under pressure and handles multiple assignments
Takes on new responsibilities
COMMUNICATION
Communicates knowledge clearly, accurately, and thoroughly
Listens attentively and responds thoughtfully
TEAMWORK
Coordinates own work with others, seeks opinions, values working relationships
SAFETY COMPLIANCE
Regularly attentive to safety and health regulations
RESPECTFUL EMPLOYEE RELATIONS
Treats all people with respect
Values diverse perspectives
Provides constructive feedback to staff
Maintains confidentiality of sensitive issues
Add all of the scores in the “Rating Column.”
Count the number of items rated. Do not include items rated N for Not Applicable. Divide the sum of all the rated items by the number of items rated and place that number in the “Average Rating” space at the right. / The sum of all of the rated items =
______
The number of items rated =
______Average Rating =
______
GOAL FOR THE 20______- 20______YEAR
(If necessary, attach additional sheets)
SUPERVISOR COMMENTS (Optional)
(If necessary, attach additional sheets)
EMPLOYEE COMMENTS (Optional)
(If necessary, attach additional sheets)

OVERALL PERFORMANCE RATING Please check one:

Highly Effective (Average score of 3.55-4.0) Effective (Average score of 2.55-3.54)

Needs Improvement (Average score of 1.55.-2.54) Unsatisfactory (Average score of 1.0 to 1.54)

______

(I) Employee’s signature Date Administrator’s signature Date

______
(II) Employee’s signature
(This signature (II) confirms that my Supervisor has provided me with, and reviewed my job description with me prior to me signing this evaluation).

*SOURCES OF DATA MAY INCLUDE ONE OR MORE OF THE FOLLOWING (Use abbreviations):

Record Review (RR); Direct Observation (DO); Supervision (S); Case Conferences (CC);Client Feedback (CF); Auditor Feedback (AF); Staff Feedback (SF);

Personnel Record (PR).

SUMMARY OF PERFORMANCE (Attach additional sheets, if necessary)

Numerically rate whether the employee’s performance has exceeded, met or not met the performance standards. Be as specific and quantitative as possible. If the performance is numerically rated either: 1) Unsatisfactory or 2) Needs Improvement, please provide a written description of performance. For ratings of 3 and above, a numerical rating in the right hand column is sufficient.

**PERFORMANCE RATINGS: 1 = Unsatisfactory 2 = Needs Improvement 3 = Effective 4 = Highly Effective N = Not Applicable

PLEASE FORWARD COMPLETED EVALUTIONS TO THE HUMAN RESOURCES DEPARTMENT