Powerpoint.

Selection & Implementationof a MIS System in Collaboration with 3 Agencies

Stephen Christian-Michaels

Family Services of Western Pa

March 1, 2004

Overview

Selection

Collaboration

Negotiation

Implementation

Selection

Self Assessment

Window shopping

Demonstrations

Estimating Costs

Request for proposals (RFP/RFI)

Work Flow Re-Engineering

Self Assessment:Modules Needed

Billing systemElectronic consumer record (ECR)Human resourcesPayrollAccounting (AP, GL)OutcomesRisk managementInventory of paper charts/contents

Self AssessmentType of Information System

– Off the shelf software

– Build your own

– Legacy systems

– Web enabled legacy systems

– Web based systems

Self Assessment:Types of Billing

Electronic Billing vs. Paper– 837 transmittal capability– HCFA 1500/UB92

Submittal to Web Based SystemsSubmittal to DOS based systemsSubmittal to Excel, Word etc.Other types of BillingMedicaid Eligibility

Self Assessment:Simple VS. Complex

Narrow VS. Broad Range of Programs

Single Location VS. Multiple Locations

Single Payor VS. Many Types of Payors

Office Based VS. Mobile Services

Fee for Service, Capitation, Grants

Similar Staff VS. Many types of Staff

Window Shopping - where

National Conferences – exhibit hallsState Conferences – exhibit hallsOn-Site DemonstrationsWeb castsVisit providers with new systemInvite vendors to demonstrate as local or

state associations

Window Shopping – test drive

Get a feel for how software worksHow easy will it be for staff?Get familiar with new MIS termsLearn different options availableGet initial estimates of costGet initial specifications for hardwareSee as many as you can see

Estimating Cost of Implementation

Replacement VS. Re-engineering

Estimate cost efficiency - reduced staff

Estimate cost of implementation

Estimating Cost of Implementation

Internal IS Staff VS. Consultant– Do Internal IS Staff have new vision/skills– Consultant to guide the process

Costs of Conversion– Preparation of your data at your end– Conversion done by software company

Cost of HardwareCost of Infrastructure–LAN, routers, etc.

Estimating Ongoing Cost of Implementation

Comparison of vendors across:

IS license and maintenance fees

Web Based user fees

Any additional 3rd Party Software costs

IS Staff salaries

IS Consultants

Estimating Start-up Implementation Costs

HardwareInfrastructure upgradeConversion * DevelopmentTraining (external, include travel/hotel) *Internal Training – lost revenueCash Flow (reduced)Consultant * (* often underestimated)

Collect Inputs and Outputs

Inventory ALL databases around the agencyCollect all forms (inputs)Collect all internal reports (outputs)Collect all external reports (outputs)

– Billing/invoices/electronic transmissions– Licensing reports

Combine/eliminate when possibleDevelop list of Forms and ReportsPrioritize Include in contract

Re-Engineering Work Flow

Point of Entry (Intake)Clinical FormsFront Desk/SchedulingPsychiatric ServicesAccounts ReceivableChart of AccountsAccounts PayableHuman Resources

Request for Proposals

Request for Information (RFI)– Broader – allows for flexible negotiation

Request for Proposal (RFP)– Narrow definition of specifications– Required by state regulations for some

RFI/RFP Change

Re-define RFI/RFP as you learn more

Start Comparative Cost Estimate

Revise with each revision of the RFI/RFP responses

TEST Support Services

Are they open when you are open

Keep in mind different time zones

Are they customer oriented

Are they knowledgeable

Call them and see how they respond

Collaboration:Description of Agencies

FSWP– 17 million budget, 425 staff– MH&MR, Foster Care, Community Building

Allegheny East MH/MR– 14 million budget, 300 staff– MH&MR, Psychiatric Inpatient

Turtle Creek Valley MH/MR– 10 million budget, 250 staff– MH/MR, Mentoring Project

Collaboration

AdvantagesCost efficiency (1 build, 3 agencies)Best Practice used by all threeCollaborative moves beyond resistanceCan be pulled up to best of bunch

DisadvantagesTakes more meetings, more timeDifficult to come to quick decisionPulled down-lowest common denominator

Collaboration Projects

Administration– Information Systems implementing– Purchasing considering– Building Maintenance considering

Clinical Services– Crisis Residential Services proposed– Dual Diagnosis Children-MH/MR denied– Combined Crisis Array idea– Common Intake idea

Lessons Learned - Collaboration

Identify strong leadersLeaders need to be from higher up

leadership among peers, failedSet clear deadlinesDemand frequent meetingsFrequent meetings with CEO’sCEO’s present in multiple level meetings

Collaboration – Next Steps

Establish a shared corporation Dec

Hire executive director March

Develop a budget for shared corp. May

Move IS staff to shared corp. June

Negotiation

Don’t accept boiler plate contractDefine deal breakersInclude system test prior to go-liveInclude HIPAA compliance testsHelp line/support service Include help response/emergency repairRequest legal hearings in your stateEscrow deposit for software

Implementation

Coordination

Re-Engineering

Managing Culture Change

Forms

Reports

Alerts & Prompts

Interfaces

Coordination

Hired consultant

Project Manager across 3 agencies

Steering Committee – 6 staff

Work Teams

CEO MIS Committee

Ad Hoc Consultation for each agency

Work Teams

Clinical Forms

Human Resources

Accounts Receivable

Mental Retardation

Quality Assurance– Outcomes

– Risk Management

– Chart Audit

Point of Entry

Front Desk

Accounting

Medical Records

Systems Administrators

Conversion

Authorizations

Managing the Culture Change

Frequent Communication– Rationale for change – re-integration– Email, staff meetings, team leader mtgs.

TrainingCelebrate milestonesIdentify rumors early and squashIdentify early adopters, spread visionTeams - work process re-engineering

Re-Engineering

Clinical Forms – 18 months on paper– Standardized 20 forms across all programs– Eliminated double entry– Consolidated forms– One Individualized Service Plan– 2 pilots on paper– Then revised formats in electronic format– Fine tuned, worked out bugs

Caution – paper to electronic is not 1:1

Re-Engineering

Examine work flowEliminate unnecessary stepsCheck licensing requirementsEliminate “because we always have”Eliminate all double/triple entryReplace re-assessments w/ addendumsInvolve state licensing staff, avoid nibbling

around the ankles START EARLY, Get into great detail

Develop Prompts/Alerts

Prompts and Alerts eliminates reportsIdentify what you want to push at staffRemove un-needed reports from listIdentify What, Whom, When, WherePrioritize list, develop in phasesTrain staff on shift from reports to alertsPhase alerts in slowly

Accounts Receivable

All payors go through AR

Define all Fee for Service rules/payor

Clarify all per diem funded programs

Build capability-bill/not bill for absences

Bring unique programs into the fold

Interfaces

Define required interfacesExamples:

– Electronic Record/AR Accounting – Electronic Record Medicaid Eligibility– Electronic Time Sheet Payroll – Electronic Record Mailing Lists

Build Test

Security/Privileges

Develop HIPAA Privacy security levelsOperationalize “Minimum Necessary”Develop list of staff privileges by groupsDevelop list of staff – required HR fieldsLimit Systems Administrator to 1 personImplement HIPAA Security rulesFirewalls sufficient to protect data

Other Special Features

Voice RecognitionHandwriting Recognition – Tablets/PDAWireless Laptops/Tablets/PDA’sConsumer Electronic SignatureElectronic Time DocumentInternet Insurance Eligibility ChecksRemote Access

Manage Mission Creep

Be clear what is in the contractClarify modification and new ideasDelay new ideas to 2nd phase

Vendor will manage this, but

You must also manage this

Conversion

Start earlyAssess ability to do internallyRevise data fields

(accounts, programs, locations)Re-map data to new structure In Oracle – shift from codes to valuesSet up test files (early)Schedule conversion – multiple transmissionsLeave time to test accuracy of conversion

Plan for Go Live

Inform staff of tasks coming up

Send memo on transition tasks

Send set-up instructions

Send Go Live instructions – first day

Plan for After Go Live

Policies/Procedures - new work process

Use implementation structure - forward

Use developed approval process

Develop new user/privilege/HR form

Develop remote user policy/procedure

Training

Orientation – all staff– Rationale – integrated services– Integrated software (HR, Clinical, AR, GL)

Hands On TrainingSupervisors TrainingRemedial TrainingRefresher Training

Identify Staff, Require It, Enforce It

Time Frames

Selection 6 – 18 monthsImplementation 6 – 24 months

More work re-engineering done 1st – soonerLess complex agencies – soonerLess customization – soonerLess interfaces with other software – soonerHigher sophistication with IS – soonerCross agency buy-in - sooner

Lessons Learned

Start re-engineering planning earlier

Hold work teams accountable

More focus on reports early in process

Start earlier on conversion process

The End

Questions

Stephen Christian-MichaelsFamily Services of Western Pa(412) 820- 2050 ext. [email protected]