Quarterly Report - Electronic Health Records ARPA SLFRF, Virginia Department of Health (December 2021)

Summary

The Electronic Health Records (EHR) ARPA SLFRF Quarterly Report for December 2021, dated 12/29/2021, from the Virginia Department of Health (VDH) on its American Rescue Plan Act (ARPA) State and Local Fiscal Recovery Fund initiative. The executive summary says VDH needs a comprehensive, interoperable EHR solution to collect clinical, laboratory, billing, scheduling and other health related information. It says the lack of an integrated technical infrastructure led to a higher likelihood of missed opportunities in timely public health interventions such as testing and contact tracing. The budget section states a Total Budget of $30,000,000 and, through December 31, 2021, $1,184,141 in current obligations, with one-time and recurring expense groups.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Full text

              ELECTRONIC HEALTH RECORDS (EHR)
American Rescue Plan Act (ARPA) State and Local Fiscal Recovery Fund (SLFRF)




                                12/29/2021
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 2 of 9


Table of Contents
Report Mandate                                                3
Context for ARPA Initiatives                                  3
Executive Summary                                             3
Objective(s)                                                  4
Overview of Quarterly Progress (Oct – Dec 2021)               5
  Comments on Alignment to plan submitted in September 2021   7
Anticipated Next Quarter Activities (Jan – March 2022)        7
Risks and Risk Management                                     8
Change Management Considerations                              8
Project Budget                                                9
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 3 of 9


Report Mandate
Chapter 1 Enactment Clause 1, paragraph B.2.P.5., of the amended 2021 Acts of Assembly states, “The
department shall communicate a detailed plan and implementation schedule to the Governor, the Chairs
of the House Appropriations and Senate Finance and Appropriations Committees, and the Director of the
Department of Planning and Budget by September 30, 2021. Additionally, the department shall report
quarterly to the Governor, the Chairs of the House Appropriations and Senate Finance and Appropriations
Committees, and the Director of the Department of Planning and Budget on progress made, with the first
progress report to be delivered not later than December 31, 2021.”



Context for ARPA Initiatives
The Virginia Department of Health (VDH) is excited about the opportunity presented by the appropriation
of ARPA State and Local Fiscal Recovery Funds in the August 2021 Special Session II of the General
Assembly to improve public health in Virginia. VDH views this investment as a once in a generation
opportunity and will work diligently to maximize use of funds to create and sustain these initiatives.
Simultaneously, VDH is fully engaged in responding to COVID-19 and protecting the health of Virginians.
Currently, VDH is creating project plans to minimize the impacts of the public health emergency on local
health departments in the first year and will be flexible in the implementation of these initiatives as
dictated by the emergency response. Modifications to VDH’s plans will be reflected in future quarterly
reports.



Executive Summary
Electronic Health Record (EHR) systems are patient-centered record systems that bring together key
information about a patient’s health to enable data-driven, comprehensive care delivery. EHR systems
can be used to efficiently collect data in a format that can be shared across multiple health care
organizations and leveraged for quality improvement, prevention activities, and public health reporting.
The ability for the Virginia Department of Health (VDH) to obtain a comprehensive, interoperable EHR
solution that will facilitate the collection of clinical, laboratory, billing, scheduling, and other health related
information is a critical need.

This need has been further accentuated by the COVID-19 public health response. The lack of a robust and
integrated technical infrastructure impacted health outcomes by leading to a higher likelihood of missed
opportunities in timely public health interventions, such as testing and contact tracing. EHR systems have
the potential to serve as a powerful tool to assess and improve population health outcomes through real-
time reporting and data analysis. These capabilities will better enable VDH and other health partners to
navigate the next pandemic.

VDH is seeking to identify a solution to replace its legacy patient demographic and billing system
(WebVISION). The agency seeks to interface with existing single programmatic solutions, such as the
Virginia Information Immunization System (VIIS), and serve as the main repository of information across
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 4 of 9


multiple clinical services programs including women’s health, maternity, STD, HIV, TB, and immunization.
This solution will offer strong data analytics for improving public health outcomes and comply with patient
safety and regulatory standards, including the Health Insurance Portability and Accountability Act (HIPAA)
of 1996. The goal is to deploy this capability across 120 clinic sites to serve over 250,000 patients or
400,000 clinical encounters per year.

Through the use of an EHR system and health information exchanges (HIE), VDH can leverage health
information technology to efficiently collect and share data, reduce costs and improve emergency
response times. Additionally, this technology will allow VDH to make timelier diagnoses of health
conditions that not only improve individual health, but also impact population health across various
communities in the Commonwealth.

Over the last three months, VDH has made progress in conducting a needs assessment, with
considerations for business process feasibility/validation, implementation and procurement,
infrastructure, and change management. These activities will continue into the beginning of 2022 and will
prepare the agency to begin the vendor procurement process in 2022. These accomplishments in the first
few months have set the EHR Initiative on the path to successfully implement a state-of-the-art EHR
system at VDH within the planned timeframe.



Objectives
VDH aims to fully implement a state-of-the-art EHR system for use across the Commonwealth and in Local
Health Districts (LHDs), to:

        •   Improve clinical efficiency and effectiveness of clinical services statewide.

        •   Enable delivery of safer, higher quality care for patients by allowing rapid access to accurate,
            up-to-date, and complete information regarding patient care.

        •   Reduce costs of care through decreased duplication of testing, lab procedures and medical
            visits through access to relevant and complete medical information of patients, especially for
            patients that seek care in multiple locations across the health district or across health district
            lines.

        •   Enhance transmission of EHR related financial transactions including third party billing to
            maximize opportunities for funding of essential services.

        •   Improve the patient experience via reduced clinical cycle times, enhanced two-way
            communications, and a patient portal to promote greater patient ownership of their overall
            health.

        •   Increase visibility and accountability for services provided at each LHD and fulfill
            programmatic reporting requirements for state and/or federally funded initiatives through
            report generation.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 5 of 9


        •   Positively impact employee morale as well as employee recruitment and retention since the
            availability and access to an EHR is an expectation of healthcare staff in modern clinical
            settings.

        •   Ensure the EHR meets all the Commonwealth’s rigorous Information Technology standards
            for a cloud based Commercial Off the Shelf (COTS) technology solution, and that it interfaces
            with all the required internal and external data systems.

        •   Fulfill reporting requirements for all VDH federal and state programs that use the EHR.



Overview of Quarterly Progress (Oct – Dec 2021)
Since developing an initial workplan that was submitted in September 2021, VDH has conducted
numerous activities that have advanced the EHR Initiative and positioned VDH to continue making
significant progress towards procuring an EHR vendor in 2022 and beginning system implementation. The
functional needs assessment was kicked off in October, and includes a mixed methods approach to
defining the needs and future state for the VDH EHR. The outcome of the functional needs assessment
will inform the best option for procuring an EHR solution. The functional needs assessment study includes
4 steps: a current state analysis, future state analysis, feasibility assessment, and EHR solution assessment,
with concurrent change management communications. For this phase of the initiative, 5 pilot local health
districts (LHDs) were selected for participation: Chesterfield, Loudoun, Mt. Rogers, Rappahannock
Rapidan, and Virginia Beach. These districts were selected based on their geographic representation
across rural, suburban and urban counties, significant clinical volume and range of services provided, and
leadership teams who were willing and eager to participate. In addition, specific interviews were held
with “Programs” within the Offices of Family Health Services (Family Planning, Maternal Child Health, etc)
and Office of Epidemiology (Communicable Diseases-STI/TB/HIV) to ascertain programmatic and federal
grant requirements. Key activities conducted as part of the functional needs assessment over the past
three months are outlined below in further detail.

    •   Current State Assessment

            o   Conducted data discovery and analysis to prepare for Program and Health District
                interviews:

                        Reviewed documents including previously documented use cases, business
                         requirements, gap analyses, programmatic forms, encounter forms and other
                         business process documentation.

                        Gathered and analyzed Health District and subprogram encounter and billing
                         data, including trends across pilot Health Districts and over time (2019 vs. 2021).

                        Transformed the Robert Wood Johnson county health indicators and health
                         outcomes to district level rankings and re-ranked the Health Districts.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 6 of 9


           o   Conducted 18 programmatic interviews focusing on data use, program processes, and
               future needs, resulting in the identification of programmatic EHR needs across people,
               process, and technology themes.

           o   Conducted two interviews with each of the 5 Pilot LHDs with one focusing on business
               processes and the other on clinical processes. The result of the interviews were 10 district
               level business and clinical process flows and identification of themes and opportunities
               across districts.

           o   Administered and analyzed a technology survey to establish a baseline of current
               hardware used in the clinical locations. Please see Appendix C for summary results.

   •   Future State Assessment

           o   Documented 23 functional needs and 212 supporting features derived from the results of
               the current state assessment.

           o   Conducted a Visioning Session with over 30 stakeholders from VDH Central Office
               programs and LHD providers to build consensus and prioritize the functional needs and
               supporting features an EHR, categorizing each functional area as mandatory, important
               or optional for the new EHR based on group feedback.

   •   Feasibility Assessment

           o   Conducted a gap analysis between the functional needs prioritized in the Visioning
               Session with the current Fairfax County EHR.

   •   EHR Solution Assessment

           o   Initiated the Technology Workgroup to guide the development of technical needs and use
               cases.

           o   Drafted use cases and scripts for product demonstrations.

   •   Change Management

           o   Developed an initial communications plan to structure and guide communications
               throughout the planning and implementation of an EHR.

           o   Identified and launched an EHR Champions network to serve as leaders during the
               transition to an EHR.

           o   Developed a change readiness survey to provide guidance on enhanced communications
               needed across the planning and implementation of an EHR.

   •   Project Oversight

           o   Reviewed ARPA funding requirements to inform EHR planning and decision making.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 7 of 9


            o   Coordinated with other ARPA Project Management Officers initiations including
                Broadband Initiative, LHD Maintenance Initiative, to ensure optimal project outcome.

            o   Conducted project governance through weekly Task Force Meetings and strategic
                Steering Committee meetings.



Comments on Alignment to plan submitted in September 2021

The current state interviews, future state assessment, feasibility assessment, solution assessment, and
change management communications are all important milestones of the ongoing EHR Needs
Assessment, which is on track to be completed in the outlined October 2021 - January 2022 timeframe.
The work completed has prepared VDH to begin the process for procuring a vendor in early 2022, in
alignment with the initially submitted workplan.



Anticipated Next Quarter Activities (Jan – March 2022)
The following outlines the specific activities and tasks planned for January through March 2022:

    •   EHR Solution Assessment

            o   Develop use cases and demonstration scripts based on the functional needs identified in
                the December Visioning Session.

            o   Support product demonstrations of public health EHR vendors.

            o   Update the feasibility assessment to inform the next steps in procuring an EHR vendor.

    •   EHR Solution Selection

            o   Determine the best route to procure an EHR that serves VDH’s needs. Current options
                under consideration include, enact the use of contract by other public bodies clause for
                the existing Fairfax County EHR contract or issue a request for proposals (RFP)

    •   Change Readiness Activities

            o   Launch structured communications across VDH to inform stakeholders of EHR progress
                and upcoming milestones.

            o   Administer and analyze the first change readiness survey.

            o   Update the communications plan based on the results of the change readiness survey and
                facilitate communications indicated by the results.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 8 of 9


Risks and Risk Management
    •   Risk 1 (Performance Risk): Alignment of the functional needs with functions/features of the EHR
        solution
            o Mitigation Strategy: The EHR implementation’s large stakeholder group and supporting
                 consultants will be thorough in compiling needs and evaluating the preferred software vs.
                 the identified needs. VDH will plan a multi-day product demonstration by vendors to
                 VDH’s stakeholders where the vendors will be asked to perform approximately 10 Use
                 Cases to confirm that the software is capable of meeting VDH’s needs.

    •   Risk 2 (Scope Risk): Prioritization of competing programmatic needs within the proposed timeline
            o Mitigation Strategy: Relatively early in the initiative, VDH will evaluate its core clinical
                 services and make value judgements as to which non-core programs will be included in
                 phase 1 of the initiative and which other programs are included in subsequent phases.
                 Some programs may not be incorporated in the EHR. The Leadership Team will need to
                 make these decisions in a timely manner.

    •   Risk 3 (Schedule): Dependencies on VITA’s ECOS process
            o Mitigation Strategy: VDH’s Office of Information Management (OIM) has very strong
                 technical capabilities and an excellent working relationship with VITA so the extensive
                 process is expected to move as promptly as possible.

    •   Risk 4 (Schedule): Dependency on broadband and bandwidth upgrades
            o Mitigation Strategy: VDH’s EHR Initiative team continues to collaborate closely with OIM
                 and the LHD Broadband upgrade team to ensure that each LHD’s broadband upgrades are
                 scheduled and completed prior to the rollout of EHR at each LHD.

    •   Risk 5 (Procurement): Timeliness and complexity of contract negotiations with EHR vendor
            o Mitigation Strategy: VDH plans to leverage lessons learned and start the contract
                 negotiations early in the process to stay on schedule



Change Management Considerations
VDH understands that transformation initiatives are successful not only with the right technology,
processes, and resources, but also with people who are properly equipped for the changes. Successfully
navigating transformation in a highly complex environment requires effectively managing business
process changes, communications, and stakeholder management to create buy-in at the early stages. As
indicated in the Completed Activities section above, VDH has developed and begun implementing a
change management and communications strategy to establish employee understanding of the EHR
Initiative and the impacts it will have to their individual jobs. The strategy includes communication of the
goals of the upcoming changes, preparation and alignment of the changes, and an overall building of
confidence in the benefits of the changes.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2021
Page 9 of 9




Project Budget
The following budget is broken down by the project categories defined in the work plans submitted on
9/30/2021. Please refer to this documentation for further clarification.

Total Budget: $30,000,000



Cumulative Expenditures, Obligations, and Budget, through December 31, 2021

 Project Group                            Current             Current     Projected FY22       Total Budget
                                      Expenditures         Obligations            Budget
 Phase 1 - One-Time Expenses                    $0         $1,184,141         $9,800,000        $15,220,000
 Phase 2 - One-Time Expenses                    $0                  $0                $0         $6,990,000
 Phase 3 - One-Time Expenses                    $0                  $0                $0         $3,830,000
 Recurring Expenses                             $0                  $0         $200,000          $3,960,000
 Total                                          $0         $1,184,141       $10,000,000         $30,000,000


File and source

File

2021-RD868.pdf

Size

268,106 bytes

SHA-256

e161c919f7df2fc0b48a18dc945fa053e8a893ae1e9f234f75b5bfa571c95dea

Our copy

2021-RD868.pdf

Original

No public link identified.