EHR IMPLEMENTATION AND ADOPTION NYeC Education Sessions

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EHR IMPLEMENTATION AND ADOPTION NYeC Education
Sessions
The Statewide Collaboration Process

• January April 2009
• EHR Collaborative Work Group

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Agenda

• Welcome and introductions
• Education session background
• NYeC
• EHR Collaborative Work Group
• Session content and dates
• Housekeeping
• Todays session

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New York eHealth Collaborative (NYeC)

• NYeC was founded by health care leaders across
  the state, with leadership and support from the
  New York State Department of Health, as a
  public-private partnership that will serve as a
  focal point for health care stakeholders to build
  consensus on state health IT policy priorities,
  and collaborate on state and regional health IT
  implementation efforts.
• Key strategies and activities include
• Developing Health IT and HIE Policies and
  Standards
• Evaluating and Establishing Accountability
  Measures for NY's Health IT Strategy
• Convening, Educating, and Engaging Key
  Constituencies

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NYeC
For more information, please visit
www.nyehealth.org
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NYeC Education Sessions
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The Statewide Collaboration Process
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FYI
The views offered by the presenters in this
program are solely their own and do not
necessarily reflect those of the New York eHealth
Collaborative (NYeC) or any of its constituents.
The faculty presenting have no financial
interests or relationships to disclose. 
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The Statewide Collaboration Process
Getting Started Strategic Roadmap and Project
Planning
How One CHITA Plans and Unfolds Its Roadmap
EHR Education Session 1 January 12, 2009 1100
am 1230 pm
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Session Placement and Summary
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The Statewide Collaboration Process
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Inverse Bibliography (you are only as good as
your sources)
Strategy without tactics is the slowest route to
victory. Tactics without strategy is the noise
before defeat.
- attributed to Sun Tsu The Art of War
Operational effectiveness and strategy are both
essential to superior performancebut they work
in different ways.
- Michael Porter What is Strategy
High performance operating processes are
necessary but not sufficient for enterprise
success. You can have the best processes in the
world but if your governance processes dont
provide direction and course correction then
success is a matter of luck.
- Michael Hammer Redesigning
the Practice of Management
If you cant describe your strategy in 20
minutes, in simple plain language then you
havent got a plan. What you have is a complex
conversation about a plan or a strategy
- Larry Bossidy Ram
Charan - Execution
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Why Brooklyn?
23 of Brooklyn residents indicate that they
have no personal doctor. This rate is
approximately 30 or more in the neighborhoods
served by many of the PCHIC CHITA participants
Sunset Park, Central Brooklyn, East New York and
Bushwick/Williamsburg.
23 of adults in Brooklyn are obese. Again, this
rate is higher in the neighborhoods served by
many of the participants in the PCHIC CHITA.
10 of Brooklyn residents have been diagnosed
with diabetes. Diabetes rates are also higher in
several of the neighborhoods served by PCHIC
CHITA participants.
5 of Brooklyn residents have asthma. Rates of
hospitalization for asthma are significantly
higher than Brooklyn-wide or citywide rates in
the communities of East New York,
Bushwick/Williamsburg, and Central Brooklyn that
are served by PCHIC CHITA participants.
The Value of Electronic Health Records In Solo or
Small Group Practices, Health Affairs, 2005,
Volume 24, Number 5.
Community Health Profiles, NYC DOHMH, 2006,
available at http//www.nyc.gov/html/doh/downloads
/pdf/data/2006chp-204.pdf The State of Diabetes
in New York State A Surveillance Report, NYS
Dept of Health 2007, Table 3 Community Health
Profiles
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Executive Summary
This webinar presents

• The Elements of HIT Strategic Planning
• Strategic Themes
• Goals and Objectives
• Prioritization
• Alignment and Congruence
• Critical Success Factors (CSF)
• Key Performance Indicators
• SWOT
• Issues anticipation and contingencies
• Roles Responsibilities
• Time (Balancing Long Term and Short Term)

• Coordination considerations in a
  multi-stakeholder, multi objective,
• shifting - priorities environment
• Translating the proposal into a project plan
• Project Planning and Execution in a highly
  Dynamic environment
• What can be managed by measurement
• Communications and Stakeholder Engagement

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Background to Approach
The Sunset Park CHITA planning process is an
evolutionary process that began at the time of
the proposal and continues.
The stakeholders, project management team along
with the adoption and support services team
subsequently identified 25 project milestones.
Each of the participating stakeholders used these
25 milestones as the basis of developing their
individualized practice plans covering
Financial Technical Operational
Adoption Support Services Coordination
Evaluation
This evolutionary approach has been adopted to
take advantage of whats known, and to work with
it while the standards groups in NYeC/SCP work
through the further ranging issues that will come
to importance later in the process.
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The Three Processes
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People
Coordination Alignment Considerations
PCDC Facilitation Team Adoption Support Services
BHIX DOHs NYeC
PCHIC CHITA Other providers
EHR Vendor Teams Consultants Internal Practice
Teams
Provider Organization Project Management
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People
Roles and Responsibilities
PCHIC (Project Director)
Sunset Park (Lead Applicant)
Project Manager
Assurance of project adherence to the terms and
condition the Grant Disbursement Agreement and
State quarterly reporting requirements,
Assurance of successful receipt and
verification of financial commitments from
stakeholders and adequate disbursement of funds
to stakeholders as appropriate Submission of
timely and appropriate payment vouchers to the
State, and assistance in management of financial
transactions with vendors.
Budget Project Management Work plan development
execution Resource Service coordination Steeri
ng Committee direction Coordination with
Stakeholders
Lead
Sunset Park eCw
Callen Lorde
PPNYC
BMP
CHN
ODA
AHRC
BedStuy
BMS
Vendor selection Integration Management and
customization Data analysis validation and
quality improvement
Strategic plans Readiness and needs
assessment Workflow redesign Implementation
NYCDOHMH
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People
Staffing Levels
(Project Director) .3FTE
Sunset Park (Lead Applicant)
Financial Accountant .5FTE
Project Manager 1 FTE
Admin. Assistant .5FTE
PCDC Team Lead 1 FTE (1) Project Mgrs 1 FTE(2)
Medical,Executive, IT Director
Lead
Sunset Park eCw
Callen Lorde
PPNYC
BMP
CHN
ODA
AHRC
BedStuy
BMS
Executive Director, Medical Director, Clinical
Staff, IT Staff, Billing Staff
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People
Stakeholder Communications Engagement
Typical Steering Committee Agenda
HEAL 5 NYeC News
Budget/Invoicing/Disbursement Process
Instructions/review
CHC Status Report/Milestone Review
PCDC Adoption and Support Status Report
Milestone Variance (Why targets get hit or
missed)
Whats working and whats not
Competing Priorities and Environmental Threats
ACTION PLANS
After action review
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Goal Guidelines
Strategy
Understandable Concrete Achievable Measurable
Sustainable Supports and Enables Provider
Organization Strategy Provider
Organization Capability and Capacity Align with
local (City), State, CHITA and RHIO Value Based
Planning
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Planning Tracks
Strategy
Planning Stages
CHITA Development Plan
State Plan
Proposal Plan
Live Plan
Manatt/Phelps Consult
PCDC CHC Assessment
CHITA Development (Sunset Park)
Proposal Draft/Plan
CHITA Organization (Sunset Park)
Milestone Development
Budget Development
Plan Execution
Responses Adjustments
Plan Coordination
New Issues Environment Changes
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Implementation Proposal vs. D.I.P.
Strategy
Proposal
Detailed Implementation Plan
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Inventory of Goals and Objectives
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Consolidated Goals and Objectives
Strategy
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Goals with a More Mission Statement Slant
Strategy
1.  To support the implementation of EHRs in 9
primary care provider organizations in
Brooklyn, NY, by providing access to technical
assistance, to forums to share best practices,
and funding. 2.  To bring these provider
organizations to a state where they are
technically capable or close to capable to
accomplishing Health Information Exchange (HIE)
through the Brooklyn RHIO, BHIX. 3.  To provide
post-EHR-implementation support in data quality,
reporting and clinical decision support
initiatives. 4.  To develop replicable models
for technical assistance and implementation
support that can be shared among the
participating organizations and offered to other
organizations after the project's
completion. 5.  To develop replicable models,
through the project's 2 use cases, of the use of
HIE to create a "care coordination zone",
enabling continuity of high quality, efficient
and safe health care across different provider
settings. 6.  To complete those elements of the
project within our control on time and on budget.
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CHC HIT Capability
HIT Adoption and Support Assessment Tool

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Planning Considerations for Different Start and
End States
Strategy
Starting States
End States
HIE Readiness
HIE Capable
HIE Functional
No EHR
Implementing PM First
Implementing EHR
On EHR 6-12 Months
ODA
BMS
CHN
BMP
PPNY
CL
AHRC
SSP
BedSty
Adoption Support Services
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Milestones
Strategy
Planning Phase
Implementation Phase
Post Implementation Phase
Execution
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(No Transcript)
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Issues and Potential Game Changers for CHITAs and
Providers to Consider
Execution

• Evolving State of HIE Infrastructure
• Evolving State and Compatibility of use
  cases with BHIX and CHITA
• Evolving State and Quality of data
  exchange sets
• Need to Digest Impact of First Release
  (11/3) of NYeC/NYS Standards
• EHR
• Security Privacy
• HIE Infrastructure
• Estimating
• Amount of Administrative work
• Amount of documentation
• Threats
• Provider Organizations competing priorities
• Productivity Impacts of Go-live on Provider
  Organizations
• Financial and Human resource requirements

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Goal Critical Success Factors CSFs
Execution

• Critical Success Factors
• Allocation HEAL Funds for Adoption and Support
  Services
• Adoption of approved EHR application
• Recognition and reduction of competing
  priorities
• Ability of provider organization to sustain
  effort for 18 months
• Developing the appropriate deliverables
• Managing and Meeting Deliverables

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Key Performance Indicators (examples)
Execution
Key Performance Targets
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Strategic Plan Statement
Strategy
Improvement Plan For Brooklyn
Saturate Provider EHR adoption in the Brooklyn
Care Coordination Zone to ensure that a critical
mass of information is flowing
Goal
Tailor and test a mass customized set of adoption
support services to ensure more effective use of
EHRs for quality care and quality-based
reimbursement.
Achieve the goals by managing a 25 milestone
project/process which will place 9 provider
organizations in the Brooklyn CHITA in any one of
three acceptable states HIE ready HIE
capable HIE functional
How
Outcome
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Relationship and Information Flow Map
SHIN-NY (State Health Information Network)
INS
CMS
BHIX (Brooklyn Health Information Exchange)
RLS MPI
Rx
Lab
NYCDOH
Brooklyn CHITA
Lead
Sunset Park eCw
ODA eCw
BMS NG
Callen NG
PPNYC eCw
CHN eCw
AHRC ?
BedStuy eCw
BMP eCw
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If we could do it all again what would we do
differently

• 1.  Build more assumptions and planning around
  Practice Management System
• Build more quantitative measures into the
  assessment process
• Build deeper contingency and alternative plans
  for worst case scenarios
• Allocate more resources for administrative,
  documentation, communications, and presentation
  needs
• Flesh out the use cases with more detail and
  earlier in the process

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Lessons Learned
1.  Define your terms.  When working in a group
to budget and plan, make sure everyone has the
same definition of key terminology. e.g. 2. 
Maximize flexibility for your participants.Consid
er every decision through this filter because
large HIT projects can contain many
surprises. 3.  Provide templates and other tools
to simplify complex requests for information and
data from your participants. They will appreciate
it  and it will increase your chances of getting
comparable information from all parties. 4. The
longer the effect of a plan, and the more
difficult it is to reverse, the more strategic it
is. Plan for the longest period worth considering
and anticipate change. 5. The more functions of
an organizations activities are affected by a
plan the more strategic it is. Overestimate
alignment, coordination, and administrative
activity.
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The Statewide Collaboration Process
Getting Started Strategic Roadmap and Project
Planning
How the Sunset Park CHITA Plans and Unfolds Its
Roadmap
Q A
Ron Hunt Project Manager, HEAL 5
Peter Cucchiara Director HIT
Lisa Perry Director, PCHIC
Community Health Care Association of NY State
535 8th Avenue, 8th FloorNew York, NY 
10018Phone  [phone]rhunt_at_CHCANYS.org
Community Health Care Association of NY State
535 8th Avenue, 8th FloorNew York, NY 
10018Phone  [phone]lperry_at_CHCANYS.org
22 Cortlandt St. New York, NY 10007 212-437-3921 p
cucchiara_at_pcdcny.org
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Bibliography
Robert S. Kaplan, David P. Norton, The Execution
Premium (Boston Harvard Business Press,
2008). Larry Bossidy, Ram Charan, Execution
(New York Crown Business, 2002). Russell L.
Ackoff, Ackoffs Best. His Classic Writings on
Management (New York John Wiley Sons,
Inc. 1999). Chapter 6 The Nature of
Planning Chapter 7 Alternative Types of
Planning Chapter 8 Problem Treatments Chapter
9 Mess Management Chapter 10 Ends
Planning Chapter 11 Mission Statements Chapter
12 Creativity and Constraints Mervat Abdelhak,
Sara Grostick, Mary Alice Hanken, Ellon Jacobs,
Health Information Management of a Strategic
Resource 3rd Edition (Philadelphia Saunders
Elsevier, 2007).
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Presenter Biography
Peter Cucchiara, BSMIS, MBA
P
eter Cucchiara is a senior HIT
Executive with over 27 years experience. He adds
value in small to mid - size private
and public companies by leveraging Information
Technology as a catalyst for business growth.
He leads efforts in strategic plan realization,
business and product development for many types
of Healthcare and Healthcare Professional
Services organizations. Further areas of
experience include organizational embrace of
technology, operations, Electronic Medical
Records and medical informatics. As the
Director of Healthcare Information Technology
(HIT) at Primary Care Development Corporation
(PCDC), he has built a consultancy and a
portfolio of services called the HIT Lifecycle
Model. PCDC has delivered these services to over
29 community health centers throughout New York
City and New York State for the purpose of
improving primary care. Previously, Mr.
Cucchiara was the Vice President of Information
Systems for Integramed America. Through
developing and executing an IT turnaround
strategy, Mr. Cucchiara turned IT into a company
core competency. Under his direction the IT team
developed the industry leading, award winning
Fertility Electronic Medical Record (ARTWORKS)
further turning it into a revenue producing
product and service. HIT infrastructure was
developed to support and facilitate company
growth of 10X to 119 million in revenue and to
1000 system users in 50 locations across 8
states. Prior positions include Assistant
Director of IT at The Hospital for Special
Surgery and Quality Assurance Manager for ADP.
In his community of peers, Peter participates
as an active member of the College of Healthcare
Information Management Executives (CHIME),
Healthcare Information Management Systems Society
(HIMSS), and the Technical Executives Networking
Group (TENG). Peter has lectured and
presented in several venues including the New
York Association for Ambulatory Care (NYAAC), the
National Association of Community Health Centers
(NACHC) the American Society for Reproductive
Medicine (ASRM) Seminar Series and also in both
the Centricity Health User Group (CHUG) and
McKesson User Conventions. Subjects have ranged
from Electronic Medical Record (EMR)
Implementation to Support Services Efficiency. He
also serves as an adjunct professor at New Jersey
Institute of Technology teaching business and
technology management.
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