Electronic Health Records (EHR) ARPA SLFRF Quarterly Report (March 2022)

Summary

A quarterly report dated 3/31/2022 on the Electronic Health Records (EHR) initiative of the Virginia Department of Health (VDH), funded through the American Rescue Plan Act (ARPA) State and Local Fiscal Recovery Fund (SLFRF). It states that VDH seeks a comprehensive, interoperable EHR solution to replace its legacy patient demographic and billing system (WebVISION), with a goal of deploying it across 120 clinic sites. It reports product demonstrations, sandbox sessions and technical follow-up meetings for Cerner and Patagonia Health, and lists activities planned for April through June 2022. The budget section gives a total appropriation of $30,000,000 and an FY22 appropriation of $10,000,000.

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




                                3/31/2022
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
March 2022
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Table of Contents
Report Mandate                                                3
Context for ARPA Initiatives                                  3
Executive Summary                                             3
Objective(s)                                                  4
Overview of Quarterly Progress (January – March 2022)         5
  Comments on Alignment to plan submitted in September 2021   7
Anticipated Next Quarter Activities (April – June 2022)       7
Risks and Risk Management                                     8
Change Management Considerations                              8
Project Budget                                                9
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
March 2022
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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.
It is a critical need 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.

This need has been further accentuated by the COVID-19 public health response. The lack of a robust and
integrated technical infrastructure negatively impacted health outcomes by leading to a higher likelihood
of missed opportunities in timely public health interventions such as testing and contact tracing. Moving
forward, 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
multiple clinical services programs including family planning, maternity, STI, 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)
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
March 2022
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of 1996. The goal is to deploy this capability across 120 clinic sites to serve over 250,000 patients and
support 400,000 clinical encounters per year.

Using 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 significant progress in conducting an EHR solution selection
through product demonstrations, sandbox sessions and technical follow-up meetings. The conclusion of
these activities prepared VDH to request references and pricing as a final step in selecting a product and
beginning the procurement process. These accomplishments have set the EHR Initiative on the path to
successfully implement a state-of-the-art EHR system at VDH within the planned timeframe.

Objective(s)
VDH aims to fully implement a state-of-the-art EHR system for use across the Commonwealth and in Local
Health Districts (LHDs) in order 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.

●   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.

●   Positively impact employee morale as well as employee recruitment and retention given that the
    availability of 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 required
    internal and external data systems.

●   Fulfill reporting and compliance requirements for all VDH federal and state programs that use the
    EHR.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
March 2022
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Overview of Quarterly Progress (January – March 2022)
Since completing the Needs Assessment and prioritizing the business functions and features for VDH’s
EHR in December 2021, VDH has engaged in the EHR Solution Selection. To expedite the procurement of
an EHR product, VDH elected to focus on two products that are both currently engaged within the
Commonwealth and have public health capabilities: Cerner and Patagonia Health. The EHR Solution
Selection process included developing use cases and scripts to guide product demonstrations, analyzing
each vendor’s Priority Feature Matrix, conducting a series of deep dive sandbox sessions for each product,
and conducting technical follow-up meetings to explore each product’s ability to meet the
Commonwealth’s technical and security requirements. Additionally, the VDH project manager has met
with the Virginia procurement office to ensure that all state procurement requirements are met. To gather
as many inputs and insights from across VDH programs and health districts as possible, the EHR planning
initiative has included over 131 stakeholders across 29 of the 35 health districts and all Central Office
divisions to date. Key activities conducted as part of the EHR Solution Selection over the past three months
are outlined below in further detail:

    •   Product Demonstrations

            o   Received subject matter expert feedback and finalized 6 clinical use cases and scripts
                (Tuberculosis, Family Planning, Home Visiting, STI, and Immunization), 1 pharmacy use
                case and script, and 1 business use case script.

            o   Developed a demonstration score card that captured inputs on the user friendliness of
                workflows and the presence of prioritized features.

            o   Developed an observed feedback form to gather inputs from the 50 VDH stakeholders
                who could attend only a portion of the demonstrations.

            o   Conducted participant training to prepare the 20 VDH subject matter experts to score the
                demonstrations.

            o   Conducted 2 four-hour demonstrations and debrief meetings after each demonstration.

            o   Gathered, compiled, and analyzed the VDH score card data, debrief inputs, and observer
                feedback. Data from the demonstrations indicated that Patagonia had an average user
                friendliness rating of 5.6 (very intuitive) while Cerner’s overall user friendliness rating was
                4.3 (neither difficult nor intuitive). Additionally, based upon the VDH participants scoring,
                Patagonia demonstrated 76% of the features while Cerner demonstrated 46%.

    •   Priority Features Matrix

            o   Finalized the list of priority features, including features identified through the
                development of the use cases and scripts.

            o   Finalized the Priority Features Matrix, which includes the functions, features with
                definitions, VDH prioritization, Vendor availability rating drop-down (Available,
                Customization Needed, Third Party, Not Available), and a place for comments.
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ARPA SLFRF Quarterly Report
March 2022
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           o   Gathered and analyzed the vendors’ self-rating on the Priority Features Matrix.

           o   Refreshed the Feasibility Assessment with the vendor’s self-rating of features. Results
               show both vendors reporting that just over 90% of the prioritized features are available
               through their products. The vendors did have differences as to specific features that are
               not available, which VDH will need to consider options to address.

   •   Sandbox Sessions

           o   Worked with vendors to prepare for deep dive demonstration sessions into 7 functional
               areas including, billing, STI/HVI, Immunization, Pharmacy, Family Planning &
               Reproductive Health, Tuberculosis, and Audit.

           o   Developed feedback form for VDH participants including clinical and business health
               district staff, VDH programmatic office staff, and VDH administrative office staff.

           o   Conducted 7 Patagonia Sandbox Sessions and 7 Cerner Sandbox Sessions, gathered and
               synthesized feedback, and identified gaps in functionality.

   •   Technical Follow-up Meetings

           o   Conducted Technical and Data Workgroup sessions to focus on technical, data and
               security functionality. This workgroup provides collaboration across the Office of
               Information Management and VITA to guide the selection of the EHR product.

                      Conducted Interface and Systems break-out meetings to triage interfaces,
                       systems, and information sharing (Excel and paper documentation) to be
                       included in the EHR.

                      Conducted Data Migration and Records Management break-out meetings to
                       begin to develop a data migration plan and consider future of legacy systems.

                      Conducted Lessons Learned break-out meetings to begin to gather lessons
                       learned across the system development lifecycle from Virginia IT implementation
                       projects in order to inform implementation planning.

                      Conducted Technical Follow-up break-out sessions to identify essential
                       information to be gathered during the technical follow-up meetings with the
                       vendors.

           o   Scheduled and conducted the technical follow-up meetings with Patagonia and Cerner.

   •   Change Management

           o   Developed and managed stakeholder tracking to include volunteers, type of participation,
               role, and programmatic and health district representation.

           o   Drafted and disseminated communications to stakeholders.
Electronic Health Records (EHR)
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March 2022
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    •   Project Oversight

            o   Continued to coordinate with other ARPA PMO initiations including Broadband Initiative
                and LHD Maintenance Initiative to ensure optimal project outcomes.

            o   Conducted twice weekly initiative status report meetings to track activities and identify
                risks.

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

            o   Presented to the Agency Forum and Local Health District meeting regarding the EHR
                initiative progress and next steps. Solicited volunteers from all parts of the agency to
                participate in initiative activities.



Comments on Alignment to plan submitted in September 2021

The product demonstrations, sandbox sessions, and technical follow-up meetings are all important
milestones towards selecting an EHR product, which is on track to be completed in the outlined
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 (April – June 2022)
The following outlines the specific next quarter activities and tasks planned from April through June 2022:

    •   EHR Solution Selection

            o   Gather vendor references and conduct referral interview

            o   Draft scope of work

                       Detail VDH and vendor roles and responsibilities

                       Finalize the requirements traceability matrix

            o   Request pricing proposals from vendors

            o   Initiate contracting with selected product vendor

    •   EHR Planning

            o   Continue to catalog and reconcile VDH processes, forms, assessments, and reports

            o   Complete data migration and record management planning

            o   Complete interface and systems mapping
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
March 2022
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            o   Develop high-level implementation roadmap

    •   Change Readiness Activities

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

Risks and Risk Management
    •   Risk 1 (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 2 (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 3 (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 4 (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 successful transformation initiatives rely on more than just the right technology,
processes, and resources. They also depend on effective change management, engagement, and training
strategies to equip impacted stakeholders with the information and guidance that they need to support
the changes being implemented.

In building and executing a robust Organizational Change Management (OCM) Strategy and Plan, VDH will
build support for the transition to Electronic Health Records and prepare stakeholders for this change,
which will in turn accelerate the new systems capability, minimize disruptions to daily operations, and
reduce the risk of project delays. As indicated in the overview of quarterly progress above, the agency has
begun to develop the necessary resources – including an initial analysis of initiative stakeholders – that
will serve as the foundation for the OCM plan. The agency is also developing an EHR “Case for Change”
that VDH Leaders will use to effectively communicate with and engage stakeholders on the importance of
the change. Additional activities may include a change readiness assessment, Change Champion network,
communication/engagement strategy, and training plan to guide VDH in its efforts to prepare
stakeholders for adoption of the new technology.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
March 2022
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Project Budget
The following appropriation 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 Appropriation: $30,000,000
FY22 Appropriation: $10,000,000

Cumulative Actuals, Obligations, and Appropriations, through March 14, 2022

 Project Group                        Current Period           FY22 YTD         FY22 YTD               FY22
                                             Actuals             Actuals       Obligations    Appropriations
 Phase 1 - One-Time Expenses                 $527,000           $527,000         $1,185,000       $9,800,000
 Phase 2 - One-Time Expenses                        $0                $0                 $0              $0
 Phase 3 - One-Time Expenses                        $0                $0                 $0              $0
 Recurring Expenses                                 $0                $0                 $0         $200,000
 Total                                       $527,000           $527,000         $1,185,000     $ 10,000,000
*Actuals represent transactions that have posted in Cardinal Web F&A as of 3/14/2022


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