AHCCCS - 2007 Medicaid Transformation Grant Final Report

5.5 Activities/Deliverables Funded
Deliverables funded for the web-based electronic health record included all phases of project including the market scan, development of the project goals and direction, formation of the non–profit organization, as well as implementation of the pilot sites.

5.5.1 Provider Survey
The Provider Survey was administered at the time of the Arizona Medical Board and Arizona Board of Osteopathic Examiners licensure renewal, and results are fully described in Sections 3.5.3 and 5.2.1 and has been included with this report. The purpose was to determine the EHR landscape in Arizona and to identify attitudes and perceptions of HIE. Primary findings relevant to EMR use indicated that approximately 75% of practitioners use paper base medical records, and only nine percent use fully functioning EMR. This is consistent national statistics presented in a New England Journal of Medicine report stating that four to nine percent of physicians utilize a fully functioning EMR1. This survey informed the PACeHR project team about the amount of assistance needed across the State, the types of providers in need of assistance, and where potential pilot sites could be located to best inform the EHR facilitation process.

5.5.2 Web-Based Letter of Interest
Local provider organizations distributed information about the web-based survey designed to collect practice demographics, number of patients seen, percentages of payor types in the practice, and level of interest and willingness to pay for EHR adoption assistance. As described in Section 5.2.1, over 1,100 practitioners responded to the survey and indicated interest in a program to assist with their EHR adoption process.

5.5.3 PACeHR
The formation of PACeHR was the largest undertaking of the project and the process produced several deliverables. First, PACeHR transitioned from the Collaborative Purchasing Program, to a 501(c)3 non-profit organization. Members include subscribers (providers and staff), services partners and community stakeholders. Representatives from state professional associations and stakeholder organizations serve on the PACeHR Board of Directors, and are planned for the Council and Workgroups: Contracts Workgroup; Measures and Reports, Incentives and Services, and Users Ombudsman Workgroups (Figure 1). PACeHRs roles and responsibilities included:

• Identifying company(s) that can provide, maintain and support a hosted web-based EHR, meeting the requirements outlined in this document
• Facilitating the process by which provider enters into contract with EHR company
• Facilitating issues resolution, including user ombudsman representation through PACeHR
• Engaging, maintaining, facilitating and empowering key stakeholders (including, but not limited to the organizations listed below) to participate in the selection, promotion and implementation of the selected web-based EHR solution through PACeHR.
• Assisting in the dissemination of selected company(s) information to providers, and local chapters of stakeholder organizations.

5.5.4 PACeHR Website
The PACeHR website was created to provide information to the community and gather early adopter interest data. The website consisted of:

• Home: general information and membership benefits
• About Us: the Board of Directors, governance, a technology partner selection
• Membership: benefits of membership
• Events: PACeHR events including vendor demonstrations
• Resources: Literature supporting EHRs
• Frequently Asked Questions
• Press: press releases and media relevant to PACeHR

The sitemap has been included with this report.

5.5.5 Board of Directors
The Board of Directors was assembled to encompass multiple specialties and practice types and create a cohesive set of bylaws governing the organization. Responsibilities of the Board include ensuring that the organization will:

• Engage, facilitate and empower key stakeholders to participate in the selection, promotion and implementation of the web-based EHR solutions and services
• Maximize health care stimulus package incentives (American Recovery and Reinvestment Act-ARRA)
• Oversee standard agreements for services and products
• Provide oversight of management and utilization report outcomes that allow transfer of certain data sets to other providers, health plan (s), AHCCCS, and/or other entities and individuals as permitted by HIPAA and when authorized by provider.

5.5.6 Business Plan
The PACeHR Team undertook constructing a Business Plan early in the process in order to determine the market landscape, provide customer and competitor analyses, present products and services, and develop operations and financial plans. This document is dynamic and continually updated due to the dynamic business environment, and the need to update products and services to meet practitioner EHR requirements.

5.5.7 Standardized Inquiry
This purpose of the SI was to identify a company(s) to provide a web accessible EHR. Each EHR company provided a written response. The SI required the offeror to deliver and maintain an affordable, interoperable, CCHIT-certified (or eligible), high-performing web-based electronic health record system, including support and maintenance. The products selected are intuitive, flexible, modular, scalable, and designed to provide the structured reports needed to support the broad range of local and national quality, value, safety, transparency and population health initiatives. This process provided a standardized methodology by which vendors were vetted.

5.5.8 Master Agreement, Data Sharing and Data Use Agreements
The PACeHR Project Team established a Master Agreement between Vendors and PACeHR that required significant legal resources. PACeHR engaged EHR consultants to identify the key components mandated for a successful contract with an EHR vendor, including Service Level Agreements (SLAs) which are typically overlooked when a small provider practice attempts this process alone. Legal counsel was a critical partner in the negotiations as each EHR vendor had almost unlimited legal resources involved in presenting their requirements for the Master Agreement.

5.5.9 Evaluation Panel
PACeHR formed a statewide volunteer Evaluation Panel to contribute to the vetting process of vendors. Twelve medical community leaders froma wide range of professional organizations, specialties, and geographies, volunteered their time, knowledge, and expertise to objectively and thoroughly review the final proposals in-depth - over 500 requirements each. . In addition to the volunteers, the Gartner Group, both health care and information technology industry consultants, was engaged to provide project oversight for the procurement process. AHCCCS also retained information technology experts to more completely evaluate the technology component of the responses. Additionally, the evaluation process included community forums for vendors to provide a full demonstration of their product.

5.5.10 PACeHR Services PACeHR Services
The PACeHR core product is an affordable web-based EHR system subscription that includes support services before, during, and after implementation. The objective of PACeHR is to help providers select, implement, and use EHRs effectively. PACeHR will provide services designed to enhance EHR implementation. Each PACeHR subscription includes a pre-determined package of services for a set monthly fee paid to PACeHR. These services, at a high-level, will include generous access to these services (as well as a pre-negotiated hourly rate if additional services are desired). In addition to the service packages, other services & products designed to increase the success of the EHR implementation process are available.

PACeHR products and services are displayed in Table 3

Table 3 PACeHR Products and Services Summary

Further detail describing the components and levels of service packages and assistance are described below.

• Service packages – implementation hand-holding, training, reports, efforts to reach meaningful use
  • Level 1 – $100 per provider / month for an average of 3 hrs / month
  • Level 2 – $145 per provider / month for an average of 5 hrs / month
  • Meaningful use package – priced individually; will include access to reporting products
  • Non–PACeHR EHR users – support other EHR systems (through PACeHR staff and/or sub-contractors)
• Infrastructure Assessments – services to assess a provider´s current infrastructure content, identify what is re–usable based on vendor selection, and what additional equipment is needed to meet the vendor requirements.
  • Level 1 package – assessment only
  • Level 2 package – assessment + procurement support
  • Level 3 package – assessment + procurement support + installation + testing
  • Level 4 package – this might just be consultation if they have their own IT resources but want extra re–assurance they meet the vendor requirements
• Hardware Discounts
  • Procurement Process – set process of where to go for the PACeHR EHR standard configurations
  • Infrastructure Discounts – similar to above but by going through PACeHR suppliers, they can calculate what equipment they´ll need, order it, pay for it and/or also get financing, and then arrange for installation services
  • Internet package – PACeHR will work with internet providers to get a PACeHR package / discount
  • Financing – provide set resources providers can access to finance their infrastructure and/or their implementation / set up fees
• EHR software Financing – offer finance options / resources for providers to access financing for the implementation costs
  • Line of Credit
  • Small business loans
  • Combine with infrastructure financing above
  • Programs through each vendor

5.5.11 Communications Plan for PACeHR
The purpose of this document was to provide community outreach by defining a communications strategy for key stakeholders and client members. Key stakeholders and constituents and objectives of the outreach were identified. Strategies were outlined to provide community awareness. Marketing and education materials were included in order to provide information, materials, and / or tools needed to accelerate the use and understanding of EHRs in Arizona. The full plan can be found here.

5.5.12 National Association of State Medicaid Directors (NASMD) EHR Workgroup Report
"A Framework for Implementing EHRs in Medicaid to Provide 1 VIEW of a Patient"

The purpose of this report was to provide a value proposition for the widespread adoption of electronic health information in Medicaid – specifically electronic health records. It provides specific guidance to Medicaid leadership on the strategies and approaches to implement electronic health records that supports health delivery system transformation. It includes a brief overview of health information technology, and provides tools to estimate Medicaid health system impact and detailed Medicaid electronic health record requirements. The report also presented issues associated with EHR implementation and offered support to providers on how to overcome these issues.

The full report can be found here.

To Section 5.6