Cuyahoga County Board of Health
(CCBH) and Regional Extension
Center (REC)
James W Coates, MS, RS
Researcher,
Epidemiology, Surveillance and Informatics
Cuyahoga County Board of Health
• Serves ~845,000 residents in Cuyahoga County, Ohio
excluding the City of Cleveland and Shaker Heights.
Why EHR at LHD?
• Participate in the Health Information Exchange
• Provide Patient Data
• Get Population Data
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Increase Revenue
Improve Productivity and Efficiency
Improve Customer Service and Quality of Care
Improve Regulatory Compliance
Keys to Success
• Senior-level Management Support
• Funding, priority setting, and executive attention
• Physician and Nurse/Staff buy-in
• Identify Champions
• Abandon inefficient processes
• Leave the “we’ve always done it that way” behind
• Maintain Constant Communication
• Understand Technology alone will not transform nursing practice
Liang, L. Connected for Health Using Electronic Health Records to Transform Care Delivery.
2010. Jossey-Bass A Wiley Imprint.
Goal
To record all patient interactions, migrate historical data from
current practice management (PM) system, track and generate
claims, achieve stage 1 meaningful use, participate in the State
health information exchange, and comply with HIPAA 5010 and
ICD-10 requirements.
CMS Incentive Flow Chart
Centers for Medicare & Medicaid Services. ICN# 905343 (September 2010)
https://www.cms.gov/MLNProducts/Downloads/Eligibility_Flow_Chart-ICN905343.pdf
History of Events
• October 2010
• REC Kick-off Meeting
• Not Eligible for REC Services
• November 2010
• Title X Letter
• December 2010
• Signed REC Agreements
Golden Ticket
*Additionally CCBH contracts with Certified Nurse Midwife
with prescriptive authority and a M.D.
REC Experiences
• Case Western Reserve University (CWRU)
• Assigned Consultant
• Welch Allyn
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Preparation Questions
Personnel
Budget
Work flows
Welch Allyn
• Preparation Questions
• Personnel
• Budget
• Work flows
CCBH Direct Services
• Immunizations
• Child
• Adult
• Travel
• Title X Family Planning
• School Based Dental Sealant
Work Flows
• Documents sequence of events between actor and the
system.
• Excellent learning experience for all
• Communicates needs to developers
• Essential for developers
Example Work Flow
Orlova, A., Johns Hopkins University, Health Information Technology Standards and Systems Interoperability Course, Spring 2011.
http://ocw.jhsph.edu/courses/infstandards/PDF/infStandards_lec5c_orlova.pdf
Fork in the Road
• System Type
• Integrated
• Include Case Management
• Interfaced
• Could Include Case Management
Case Management
• Things to consider
• Include in build out of EHR
• Comprehensive System
• Reporting
• Maintenance
• Cost
Next Steps
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Case Management?
Develop RFP
Evaluate Vendors
Vendor Selection
Timeline
Welch Allyn Process
|----------------------------|
{Deliverable: Requirement Analysis Document}
Send out RFP
|----------|
{Deliverable: Receive at least 3 proposals}
Vendor Selection
|----------|
{Deliverable: Choose 1 certified vendor}
Sys. Development
|----------------------------|
{Deliverable 1: Sys. Development Specifications}
{Deliverable 2: Working prototype / pilot}
Pilot testing & retesting
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Modification
|------|
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{D: Pilot Testing Protocol/Report}
Implementation {D: Sys. Documentation}
|-------------------------|
Evaluation & Operation {D: Ops. Manual}
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_______________________________________________________________________________
Jun-11
Aug-11
Apr-12
May-12
Jul-12
Sept-12
Nov-12
Contact Information
James Coates, MS, RS
Researcher
Epidemiology, Surveillance and Informatics
Cuyahoga County Board Of Health
5550 Venture Drive
Parma, OH 44130
Phone: 216-201-2001 ext: 1617
Email: jcoates@ccbh.net