Empire State VistA Project OSEHRA June 2017 Gerald Engel, Associate OMH Commissioner, Chief Medical Informatics Officer
OMHFacilities, Article 28/31 Hospitals andcpepsin New York State North 0 4 8 12 16 20 SCALEIN MILES L E G AdultPsychiatric Center ForensicPsychiatric Center Children spsychiatric Center Psychiatric ResearchInstitute Office of MentalHealth Adult& Children spsychiatric Center WesternNY Children spc Wheatfield Freedonia NIAGARA Niagara Falls ERIE BuffaloPC Buffalo Springville CATTARAUGUS CHAUTAUQUA TLCHealth Network Salamanca Woman's ChristianAssoc. of Jamestown, NY Olean General Hospital Jamestown Manhattan (NewYork County)Article 28/31Hospitals Beth Israel Medical Center New York Gracie SquareHospital Lenox Hill Hospital MountSinai Medical Center New YorkPresbyterianHospital New YorkUniversity HospitalsCenter NYC-HHC Bellevue Hospital Center NYC-HHC HarlemHospital Center NYC-HHC Metropolitan Hospital Center St. Luke's-Roosevelt Hospital Center QueensCountyArticle 28Hospitals Jamaica Hospital Medical Center Long IslandJewishMedical Center New YorkFlushingHospital and Medical Center NYC-HHC ElmhurstHospital Center NYC-HHC Queens Hospital Center St. John'sEpiscopal Hosp So ShoreDivision E N D Niagara FallsMemorial Medical Center Article 28 Hospital Article 31 Hospital CPEP CORTLAND Countyname BrylinHospital ErieCountyMedical Center Elmira Cityor Town name City, Town or urban area EasternNiagara Hospital NewYorkCity Region 0 1 2 3 4 5 SCALEIN MILES NYS Psychiatric Institute Manhattan PC Kirby ForensicPC KINGS ORLEANS GENESEE MONROE Newark-Wayne Community Hospital, Inc. Batavia Clifton SpringsHospital and Clinic Canandaigua WYOMING WesternRegion Olean BRONX Brockport WyomingCounty Community Hospital ALLEGANY Bronx Queens NEWYORK CreedmoorPC Manhattan New YorkCity Children scenter-queens Brooklyn Kingsboro PC RICHMOND SouthBeachPC RichmondUniversityMedical Center Staten Island Staten IslandUniversity Hospital QUEENS St. Joseph'sHospital Health Center SUNYHealth ScienceCenter-UniversityHosp. Rochester General Hospital The Unity Hospital of Rochester Hornel l Alfred STEUBEN YATES Soldiers & Sailors Memorial Hospital SCHUYLER St. Lawrence PC JEFFERSON CORTLAND Ithica Cayuga Medical Center at Ithaca, Inc. TOMPKINS LEWIS Oxford CHENANGO ST LAWRENCE CentralRegion Universityof Rochester Medical Center/ OSWEGO Strong Memorial Hospital Oswe Os g w o e H go ospital,inc. Fulton ONEIDA RomeMemorial Hospital Rochester Wolcott Rome RochesterPC HERKIMER WAYNE CentralNY ForensicPC Lyons Clyde Syracuse Mohawk Valley PC Newark HutchingsPC Utica Herkimer Mohawk Geneva Auburn AubSeunrincaCFoamllsmunity Hospital ONTARIO SENECA ONONDAGA MADISON LIVINGSTON Hamilton CAYUGA Moravia Bronx PC New YorkCity Children scenter- Bronx Cortland Regional Medical Center,Inc. Samaritan Medical Center Watertown Norwich HAMILTON FRANKLIN FULTON ESSEX CLINTON WARREN SARATOGA Plattsburgh Salem MONTGOMERY SCHENECTADY Mary Imogene BassettHospital Schenectady Ellis Hospital Samaritan Hospital Troy Albany Medical Center OTSEGO Cooperstown Capital District PC RENSSELAER Albany SCHOHARIE ALBANY Oneonta Massena Claxton-Hepburn Medical Center Ogdensburg Waddington Potsdam Malone AdirondackMedical Center Saranac Lake Lake Placid Tupper Lake St. Mary's Hospital Comprehe G n lo s v i e v r e sto M w H n Center Amsterdam PutnamHospital Center BonSecours Community Hospital OrangeRegionalMedical Center PUTNAM Mid-HudsonForensicPC ORANGE WESTCHESTER ROCKLAND Nyack Hospital RocklandChildren spc RocklandPC NathanS. Kline Institute Whitehall GlensFallsHospital GlensFalls WASHINGTON Saratoga Springs Sidney ColumbiaMemorial Hospital TIOGA BROOME Horseheads DELAWARE GREENE COLUMBIA St. Joseph'sHospitBainlghamton GreaterBinghamton ElmiraPC Elmira Health Center HudsonRiver Region CHEMUNG Health Alliance Hospital in Kingston United Health ServicesHospitals, Inc. Kingston ULSTER DUTCHESS BronxCountyArticle 28Hospitals SULLIVAN Bronx-Lebanon Hospital Center Montefiore Medical Center Catskill Regional NYC-HHC Jacobi Medical Center Medical Center NYC-HHC LincolnMedical & Mental Health Center NYC-HHC North Central Bronx Hospital St. Barnabas Hospital Brooklyn (KingsCounty) Article 28Hospitals Brookdale Hospital Medical Center Interfaith Medical Center,Inc. Kingsbrook JewishMedical Center Lutheran Medical Center Maimonides Medical Center New YorkMethodistHospital NYC-HHC Coney Island Hospital NYC-HHC KingsCountyHospital Center NYC-HHC WoodhullMedical & Mental Health Center NASSAU ChamplainValleyPhysicians Hospital MedCtr. Mid-Hudson Valley Divisionof WestchesterMedical Center Faxton-St.Luke's Healthcare St. ElizabethMedical Center Saratoga Hospital Four Winds of Saratoga, Inc. Westchester CountyArticle 28/31Hospitals Four Winds, Inc. Montefiore MountVernon New York Presbyterian/WestchesterDivision Northern WestchesterHospital Center Phelps Memorial Hospital Center St. Joseph'sMedical Center WestchesterMedical Center SUFFOLK Sagamore Children spc Pilgrim PC Suffolk CountyArticle 28/31Hospitals Brookhaven Memorial Hospital Medical Center BrunswickHospital Center, Inc. EasternLong IslandHospital Association Huntington Hospital JohnT. Mather Memorial Hospital The Long IslandHome Southside Hospital St. Cath of Siena MC-d/b/a St.CathSiena Hosp SUNY at Stony Brook-UniversityHospital LongIsland Region NassauCountyArticle 28Hospitals Franklin Hospital Medical Center Mercy Medical Center NassauHealth Care Corp/NassauUnivMedCtr North ShoreUniversityHospital SouthNassauCommunitiesHospital October 2015
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OMH Description 4 New York State Office of Mental Health (OMH) operates 24 State inpatient facilities that serve approximately 10,000 inpatient individuals each year Operates dozens of residential, outpatient, and support programs across the State. Inpatient services provide stabilization, intensive treatment, and rehabilitation with 24-hour care in a controlled environment. Outpatient services provide treatment and rehabilitation to service recipients in need of communitybased support to maintain mental health. Residential services are provided to maximize access to housing opportunities. Support programs are based in the community and help adults diagnosed with serious mental illness live as independently as possible, and help children with serious emotional challenges to remain with their families.
June 19, 2017 5 OMH Description-cont. New York State Office of Mental Health (OMH) promotes hope and recovery for people with psychiatric disabilities. With a workforce of over 15,600, OMH is both a major provider of inpatient, outpatient and residential services and the lead governmental agency responsible for statewide oversight of all public mental health services. Through its state-operated and community based programs OMH serves approximately 650,000 adults, children and adolescents each year. OMH hospitals, not the community facilities, are the ultimate safety net/tertiary providers for people with psychiatric illness. 6/19/2017 Gerald M. Engel, OMH Associate Commissioner, CMIO 5
OMH is responsible for the regulation and licensing of mental health facilities & programs other than private practices and Federal facilities. OMH provides oversight to the State's 62 counties and more than 2,500 mental health programs operated by local governments and private agencies that provide mental health services including inpatient, outpatient, emergency, residential, vocational care and community support. As the 3 rd largest hospital system in New York State behind Columbia- Presbyterian and Long Island Jewish systems, OMH meets the same standards set by CMS and The Joint Commission as Albany Medical Center or Columbia Presbyterian. 6
OMH EMR will Consolidate existing clinical systems used in OMH; Integrate with the agency lab, dental, billing systems; Enable business interoperability and collaboration among stakeholders; It will drive down overall IT costs for clinical systems in and outside of OMH. Without single integrated EMR systems, there are many staff/consultants in OMH managing/developing stovepipe operations. Without a OMH certified, open source option for the community providers outside OMH, the community facilities and programs face steep financial hurdle for adopting EMRs on their own. 7
Safety Reduction in Adverse Events CPOE Clinical Alerts: Medication interactions, erroneous errors, etc.. Consistency of Data Flow Quick access to crucial patient information Integration of data: Laboratory, Pharmacy, Clinical 8
Quality Data: the cornerstone of quality improvement Accurate and timely information Ability to track interventions withresponse in real time Elimination of inefficiencies of manual auditing Ability to drive evidence based practice Statewide system withinteroperability Ability to assess and drive best practice throughout the NYS Psychiatric Centers Improved utilization Improved intake decision 9
Regulatory Ability to demonstrate compliance The Joint Commission Expectation for the dissemination of electronic data Ongoing assessment of performance Incident Review Increased accuracy Increased timeliness Increased thoroughness I-STOP Enable OMH to meet recently enacted I-STOP regulation which requires that all prescriptions are transmitted electronically to pharmacies 10
11 Recognized after transformation Increased clinical time available to patients Decreased need for cumbersome manual auditing Information accessible more quickly: Doesn t get lost in bulky manual charts
12 OMH will install enterprise-wide electronic medical record (EMR) at 23 inpatient hospitals and 300 outpatient facilities to: Promote consumer recovery and support accountability, care coordination, and best practices; Establish a foundation for health information technology that supports the health care administration policies; Set a foundation for clinical decision support, automated quality measures and business interoperability Integrate with the agency billing system; Deliver tangible returns on investment thru operating efficiency and productivity gain;
Install e-prescribing capabilities to reduce medication errors and establishes centralized utilization review process; Modernize the clinical work environment to improve clinician recruitment and retention at the facilities; Meet national and local accreditation, clinical workflow, billing, regulatory and documentation standards; Enhance reporting capabilities and clinical information analysis for consumers, clinicians, financial, and regulatory stakeholders; and Improve patient safety by integrating uncoordinated and fragmented practices. 13
14 OMH functions as a de-centralized organization Sites are large and have many associated outpatient facilities Sites generally follow industry standard practices/processes OMH software has major issues and should be replaced Very difficult to use Usage rate is very low Redundant data entry Must be force-fitted to most processes Several sites developed Home Grown Applications Need professional documentation Need professional code review Need professional testing cycle Lack certified products and HL7 capabilities Pharmacy system is adequate Laboratory system is superior
6/19/2017 15 Gerald M. Engel, OMH Product Selection: VistA 15 Largest scale proven EMR to date. Open Source by U.S. Federal government (VA, DoD, IHS). Customized for OMH requirements, it can make a cost-effective viable EMR solution for New York State. Exceeds the needs of OMH Proven technology and Return on Investment Open Source and Cost Effective Provides vendor flexibility Allows in-house development capabilities Provides self-support capabilities Improves the overall quality of care at OMH Supports public mental health systems and community providers
6/19/2017 16 Gerald M. Engel, OMH Implementation Approach 16 Mandate use of VistA EHR Based System Must be mandated at Executive Level Computer literacy should be part of hiring requirements Require EHR use for Consulting Providers Training Critical to rapid deployment Adequately fund training Train help desk staff early on (Tier 1 and Tier 2) Train the trainer to create a pool of super users Leverage physicians with VA & VistA experience Cross train users Staffing Communicate with Staff early and often Add staff to support go-live transition Identify EMR Coordinators for clinical processes and customization early Identify Clinical Champions Full-time "template specialists" needed for clinical note template (entry form) design & creation
6/19/2017 17 Gerald M. Engel, OMH Implementation Approach 17 Implementation Approach & Benefits Centralized Hosting Centralized standard forms/template development Centralized custom application development One patch stream from Central Office Customization is possible at site level (e.g. add templates) to meet needs of patient population with Central Office Approval Legacy Systems to Keep Laboratory Most tests are sent out to reference laboratories IT system and business processes in use fulfill OMH needs Can be interfaced via HL7 NIMRS Mature system fulfills the specific needs of the mental health hospitals VistA EMR will not improve technical functionality or business processes Can be interfaced via HL7 or Cache Objects Legacy Systems to Replace MHARS MedsManager
Identifying Processes to Standardize: 18 Processes in Inpatients Admission/discharge/transfer H&P/differential diagnosis Medications reconciliation Assessment Treatment planning Medical consultation Intensive care Provider order entry Patient care charting Medication administration Patient monitoring Care coordination Service recording Reporting Processes in Outpatients Scheduling and registration/ Check-in and check-out Patient intake Results review H&P/encounter notes Treatment plan/ guidelines Medication management: medication list maintenance / prescribing/ refills/ compliance Order entry E&M coding Charge capture/service recording Patient instructions 6/19/2017 18 Gerald M. Engel, OMH
6/19/2017 19 Gerald M. Engel, OMH Proposed EMR Governance 19 Cluster Executive Review Board EMR Steering Committee Review, approve the EMR strategy and roadmap Set priorities for agency wide EMR implementation Meet bi-monthly EMR Operating Committee Develop and maintain the EMR roadmap based on the EMR strategy Develop the high level work plan and milestones Realize resource allocation for EMR program Meet bi-weekly or more frequent, monitor program progress EMR Project Management Clinical Development and Implementation Task Force Implementation Team Analysis Standards Requirement s Admin/Fiscal/Quality Committee Clinical Advisory Committee Billing System Facility Operation Quality Measurement Discover and document current clinical processes and workflow Envision and prescribe future processes and workflow Recommend change management Review and approve the clinical strategy for the EMR program Prescribe best practices Review and approve the standard clinical processes
EMR Footprint 20 Number of Inpatient Wards: 217 Number of Inpatients: 4,835 Number of Outpatient Units: 300 Number of Outpatients: 29,345 Potential number of users: 9,215 End-user Titles to be Trained Community Mental Health Pharmacy Nurse/RN Psychiatrist/Physician Dentist Pharmacy Psychologist Nutritionist Psychiatrist/Physician Rehabilitation Staff Facility Information Psychologist Center Social Worker Coordinator Rehabilitation Staff Treatment Unit Clerk Health Information Social Worker Clinical Manager Management Staff Treatment Unit Clerk Utilization Review IT Staff Clinical ManagerCoordinator Laboratory Utilization Review Coordinator Mental Health Therapy Aide 20 6/19/2017 Gerald M. Engel, OMH
6/19/2017 21 Gerald M. Engel, OMH EMR Project Timeline 21 Track is defined as one of two parallel, but not entirely concurrent sets of VistA Implementations. Track 1 will deploy a more limited, As-Is Vista product to a smaller set of end users across OMH Inpatient Facilities. Health and Safety Track 2 shall deploy the remaining Core Functions (requirements issued with the RFP) and Additional Functionality (enhancements and change requests) to an expanded end user audience across OMH Inpatient facilities and Outpatient locations. Better Patient Care
Two Track Approach Track 1 Pharmacy Lab Computerized Provider Order Entry (CPOE) Bar Code Medication Administration (BCMA) Track 2 Patient Scheduling Patient Registration Clinical Evaluations/Assessments Treatment Planning Progress Notes Document Imaging 22
23 Implementation Approach Kick Off Meeting Equipment Vist Cabling & Wifi Pre-Implementation Visit Mid Point Visit Implementation Post Implementation Support
24 What is required of facility Identify and make staff available for training, testing, meeting attendance, policy revision and implementation Temporary changes to ordering and order renewal process Install and test equipment Integrating local help desk support for VistA operations Logistical support for Central office staff and consultants, building access, security etc. Review workflows, participate in meetings, update policies and procedures as needed Availability & Participation by staff. Executive presence during calls, rounds during mentoring, sitting in on trainings.
ES VistA Key Facility Roles Facility Project Liaison 25 Facility Project Back Up Liaison Facility Training Liaison(s) Health Facilities Management Liaison & back up/designee Pharmacy Director & back up/designee Nurse Champion & back up/designee Physician Champion & back up/designee
Questions 26